Provider Demographics
NPI:1851841902
Name:HAYES, HANNAH (EDS NCSP)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:HAYES
Suffix:
Gender:F
Credentials:EDS NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 MANHATTAN AVE
Mailing Address - Street 2:UNIT C
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-3636
Mailing Address - Country:US
Mailing Address - Phone:719-369-8227
Mailing Address - Fax:
Practice Address - Street 1:1500 MANHATTAN AVE
Practice Address - Street 2:UNIT C
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-3636
Practice Address - Country:US
Practice Address - Phone:719-369-8227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA160198305103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool