Provider Demographics
NPI:1851316822
Name:HAYNES, BETH ALISON (PHD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ALISON
Last Name:HAYNES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 S WESTLAKE BLVD STE 14-130
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3108
Mailing Address - Country:US
Mailing Address - Phone:805-495-1029
Mailing Address - Fax:805-495-1020
Practice Address - Street 1:1014 S WESTLAKE BLVD STE 14-130
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3108
Practice Address - Country:US
Practice Address - Phone:805-495-1029
Practice Address - Fax:805-495-1020
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15919103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP15919Medicare PIN