Provider Demographics
NPI:1649013848
Name:HAYWOOD, CHANELLE (MFT)
Entity type:Individual
Prefix:
First Name:CHANELLE
Middle Name:
Last Name:HAYWOOD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 CENTER DR APT 668
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-8983
Mailing Address - Country:US
Mailing Address - Phone:310-686-4771
Mailing Address - Fax:
Practice Address - Street 1:10801 NATIONAL BLVD STE 222E
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-4146
Practice Address - Country:US
Practice Address - Phone:310-873-6751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-15
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT140126101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health