Provider Demographics
NPI:1336404839
Name:HAZLEHURST, ISOBEL (MFT)
Entity Type:Individual
Prefix:
First Name:ISOBEL
Middle Name:
Last Name:HAZLEHURST
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:BELLE
Other - Middle Name:
Other - Last Name:HAZLEHURST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:641 MIMOSA AVE
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-8153
Mailing Address - Country:US
Mailing Address - Phone:760-271-1601
Mailing Address - Fax:760-295-4907
Practice Address - Street 1:641 MIMOSA AVE
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-8153
Practice Address - Country:US
Practice Address - Phone:760-271-1601
Practice Address - Fax:760-295-4907
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT25557106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist