Healthcare Provider Details

I. General information

NPI: 1427274661
Provider Name (Legal Business Name): MISS JAMIE MICHELLE HAWKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 10/28/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44444 20TH ST W
LANCASTER CA
93534-2714
US

IV. Provider business mailing address

13636 VENTURA BLVD STE 126
SHERMAN OAKS CA
91423-3700
US

V. Phone/Fax

Practice location:
  • Phone: 661-951-0070
  • Fax:
Mailing address:
  • Phone: 661-951-0076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number148440
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: