MEDICARE: CATHERINE PARRA HAYNES M.S., LMFT

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	97467	CA

General Provider Information

NPI Number	:	1487296059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE PARRA HAYNES M.S., LMFT

Provider Business Mailing Address
First Line	:	1234 MUIRFIELD RD
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-5577
Country	:	US
Telephone Number	:	951-907-5361
Fax Number	:

Provider Business Practice Location Address
First Line	:	4344 LATHAM ST
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92501-0400
Country	:	US
Telephone Number	:	951-779-4917
Fax Number	:

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

Provider Enumeration Date	:	10/15/2019
Last Update Date	:	10/15/2019

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