Provider Demographics
NPI:1851802052
Name:RACHEL HAYNES MARRIAGE & FAMILY THERAPIST, PC
Entity Type:Organization
Organization Name:RACHEL HAYNES MARRIAGE & FAMILY THERAPIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MFT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSE
Authorized Official - Phone:510-776-0344
Mailing Address - Street 1:1700 NORBRIDGE AVE STE F
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5700
Mailing Address - Country:US
Mailing Address - Phone:510-776-0344
Mailing Address - Fax:510-217-9766
Practice Address - Street 1:1700 NORBRIDGE AVE STE F
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5700
Practice Address - Country:US
Practice Address - Phone:510-776-0344
Practice Address - Fax:510-217-9766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2022-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 251S00000X
CA102204106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1760703565OtherNPI INDIVIDUAL