Provider Demographics
NPI:1932684842
Name:HYDARYACIL, NAHAL NICHOLE (PSYD)
Entity Type:Individual
Prefix:
First Name:NAHAL
Middle Name:NICHOLE
Last Name:HYDARYACIL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:
Other - Last Name:HYDARY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:4413 SHADEWAY RD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-3338
Mailing Address - Country:US
Mailing Address - Phone:714-721-7110
Mailing Address - Fax:
Practice Address - Street 1:8 CORPORATE PARK STE 300
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5196
Practice Address - Country:US
Practice Address - Phone:562-231-7022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108460106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist