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NPI Code Detail

MEDICARE: ELIZABETH M HAYNES

MEDICARE: ELIZABETH M HAYNES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor12514CA
2101YM0800XMental Health Counselor12514CA

General Provider Information

NPI Number : 1053024562
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH M HAYNES
Provider Business Mailing Address
First Line : 1907 BOYS REPUBLIC DR
Second Line :
City : CHINO HILLS
State : CA
Zip : 91709-5447
Country : US
Telephone Number : 909-628-1217
Fax Number : 909-306-5427
Provider Business Practice Location Address
First Line : 14505 KRAMER RANCH RD
Second Line :
City : CHINO HILLS
State : CA
Zip : 91709-5454
Country : US
Telephone Number : 909-740-3137
Fax Number : 909-306-5427
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2022
Last Update Date : 06/28/2023

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Directions to “ ELIZABETH M HAYNES ” Practice Location

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