Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | 150133314 | CA |
NPI | 1013436815 |
---|---|
Provider Name | Patricia Hayner |
First Address | Canyon Lake, CA 92587-7493 |
Second Address | Canyon Lake, CA 92587-7493 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2017 |
Last Update Date | 16/06/2018 |