Healthcare Provider Details

I. General information

NPI: 1548174352
Provider Name (Legal Business Name): BETTY FAYE HANNAH MENTAL H/EARLY CHOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11865 CHESTERTON ST
NORWALK CA
90650-7265
US

IV. Provider business mailing address

11865 CHESTERTON ST
NORWALK CA
90650-7265
US

V. Phone/Fax

Practice location:
  • Phone: 562-556-1338
  • Fax:
Mailing address:
  • Phone: 562-556-1338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19840117
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: