Provider Demographics
NPI:1205273596
Name:HAYDEN, MARCIA C (MA, LMFT)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:C
Last Name:HAYDEN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5535 BALBOA BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1543
Mailing Address - Country:US
Mailing Address - Phone:818-501-3007
Mailing Address - Fax:
Practice Address - Street 1:5535 BALBOA BLVD STE 204
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1543
Practice Address - Country:US
Practice Address - Phone:818-501-3007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30851106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist