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General NPI Number Information
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NPI Number | 1548454499
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Entity Type | Individual
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Provider Name | LINDSEY HAILSTON
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Gender | Female
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Dates
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Enumeration Date | 09/04/2007
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Last Update Date | 02/22/2017
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Provider Practice Location Address
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Address Line | 24511 W JAYNE AVE
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City | COALINGA
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State | CA
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Zip | 93210-9503
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Country | US
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Telephone | 559-934-3532
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Fax |
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Provider Business Mailing Address
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Address Line | 7025 MORRO RD
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City | ATASCADERO
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State | CA
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Zip | 93422-4424
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Country | US
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Telephone | 805-245-9201
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY23437
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License Number State | CA
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