Provider Demographics
NPI:1669715918
Name:HAYES, JACQUELINE ANN (MFT)
Entity type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:ANN
Last Name:HAYES
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 1:2134 CONTINENTAL AVE
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3312
Mailing Address - Country:US
Mailing Address - Phone:949-631-6129
Mailing Address - Fax:
Practice Address - Street 1:2134 CONTINENTAL AVE
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3312
Practice Address - Country:US
Practice Address - Phone:949-631-6129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA260101YP2500X
CA50113106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional