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General NPI Number Information
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NPI Number | 1154735124
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Entity Type | Individual
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Provider Name | KACI LYNN HAILSTONE MA, AMFT
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Gender | Female
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Dates
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Enumeration Date | 06/17/2014
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 265 S RANDOLPH AVE STE 100
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City | BREA
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State | CA
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Zip | 92821-5791
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Country | US
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Telephone | 657-201-7949
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Fax |
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Provider Business Mailing Address
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Address Line | 265 S RANDOLPH AVE STE 250
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City | BREA
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State | CA
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Zip | 92821-5701
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 142293
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License Number State | CA
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