Provider Demographics
NPI:1255511424
Name:HAYSLETT-ATKISON, AMBER (LMFT)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:
Last Name:HAYSLETT-ATKISON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MISS
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:HAYSLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:DENAIR
Mailing Address - State:CA
Mailing Address - Zip Code:95316-0428
Mailing Address - Country:US
Mailing Address - Phone:925-918-2105
Mailing Address - Fax:
Practice Address - Street 1:1130 12TH ST STE A
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-0834
Practice Address - Country:US
Practice Address - Phone:203-324-9323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51684106H00000X, 106H00000X
CA55310101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health