Provider Demographics
NPI:1952620874
Name:DEMAREST, HAYLEY NICOLE
Entity Type:Individual
Prefix:MRS
First Name:HAYLEY
Middle Name:NICOLE
Last Name:DEMAREST
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:HAYLEY
Other - Middle Name:NICOLE
Other - Last Name:ELROD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:988 MCCOURTNEY RD
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949
Mailing Address - Country:US
Mailing Address - Phone:530-470-2444
Mailing Address - Fax:530-271-5943
Practice Address - Street 1:988 MCCOURTNEY RD
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949
Practice Address - Country:US
Practice Address - Phone:530-470-2444
Practice Address - Fax:530-271-5943
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
CAIMF 73231106H00000X
CA97513106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health