Provider Demographics
NPI:1497843874
Name:HAZARD, SALLY (LMFT)
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:
Last Name:HAZARD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 GRETNA GREEN WAY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-7437
Mailing Address - Country:US
Mailing Address - Phone:760-233-0444
Mailing Address - Fax:
Practice Address - Street 1:3355 MISSION AVE
Practice Address - Street 2:SUITE 238
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-1326
Practice Address - Country:US
Practice Address - Phone:760-754-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42180106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist