Provider Demographics
NPI:1811103377
Name:HARTELL, GAY L (PHD)
Entity type:Individual
Prefix:DR
First Name:GAY
Middle Name:L
Last Name:HARTELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:GAY
Other - Middle Name:L
Other - Last Name:HARTELL-LLOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3900 W COAST HWY
Mailing Address - Street 2:SUITE 330
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4093
Mailing Address - Country:US
Mailing Address - Phone:949-640-4050
Mailing Address - Fax:949-640-4050
Practice Address - Street 1:3900 W COAST HWY
Practice Address - Street 2:SUITE 330
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4093
Practice Address - Country:US
Practice Address - Phone:949-640-4050
Practice Address - Fax:949-640-4050
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11193103TP0016X
CAMP016330106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist