Provider Demographics
NPI:1750415758
Name:HAYWOOD, TABATHA DAWN (LMFT)
Entity type:Individual
Prefix:MS
First Name:TABATHA
Middle Name:DAWN
Last Name:HAYWOOD
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:PO BOX 2087
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95344
Mailing Address - Country:US
Mailing Address - Phone:209-381-6852
Mailing Address - Fax:209-385-3174
Practice Address - Street 1:3090 M ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-3212
Practice Address - Country:US
Practice Address - Phone:209-381-6852
Practice Address - Fax:209-385-3174
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAUNKNOWN106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist