=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417343294
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MERIDITH HAYOS LMFT, JD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2015
-----------------------------------------------------
Last Update Date | 07/12/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 185 N REDWOOD DR STE 225
-----------------------------------------------------
City | SAN RAFAEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94903-1980
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-448-6663
-----------------------------------------------------
Fax | 628-240-3925
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 185 N REDWOOD DR STE 225
-----------------------------------------------------
City | SAN RAFAEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94903-1980
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-448-6663
-----------------------------------------------------
Fax | 628-240-3925
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFT#85873
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------