MEDICARE: HAYA JAMELELLAIL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1255008173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAYA JAMELELLAIL

Provider Business Mailing Address
First Line	:	17724 HALSTED ST # A
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91325-2025
Country	:	US
Telephone Number	:	818-450-7992
Fax Number	:

Provider Business Practice Location Address
First Line	:	17724 HALSTED ST # A
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91325-2025
Country	:	US
Telephone Number	:	818-450-7992
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2021
Last Update Date	:	09/09/2021

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Directions to “ HAYA JAMELELLAIL ” Practice Location

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