Provider Demographics
NPI:1982290326
Name:HYBL, MADISON
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:HYBL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3360 CALLE ODESSA
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-8621
Mailing Address - Country:US
Mailing Address - Phone:714-917-7574
Mailing Address - Fax:
Practice Address - Street 1:285 N EL CAMINO REAL STE 219
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5385
Practice Address - Country:US
Practice Address - Phone:619-330-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT117066103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical