Provider Demographics
NPI:1912166257
Name:HAILEY, BROOKE (PHD, MFT)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:HAILEY
Suffix:
Gender:F
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14542 VENTURA BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-5512
Mailing Address - Country:US
Mailing Address - Phone:310-281-3367
Mailing Address - Fax:
Practice Address - Street 1:14542 VENTURA BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-5512
Practice Address - Country:US
Practice Address - Phone:310-281-3367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 39740106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist