Provider Demographics
NPI:1609588979
Name:HAYLOCK, CHANAE JOI (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:CHANAE JOI
Middle Name:
Last Name:HAYLOCK
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:MRS
Other - First Name:JOI
Other - Middle Name:
Other - Last Name:HAYLOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP
Mailing Address - Street 1:9291 LAGUNA GREEN CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-5047
Mailing Address - Country:US
Mailing Address - Phone:626-375-5476
Mailing Address - Fax:
Practice Address - Street 1:9291 LAGUNA GREEN CT
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-5047
Practice Address - Country:US
Practice Address - Phone:626-375-5476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024542363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health