Provider Demographics
NPI:1285705830
Name:HAYTER, JENNIFER LEE FARMER (MFT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEE FARMER
Last Name:HAYTER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12535 SEAL BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-2712
Mailing Address - Country:US
Mailing Address - Phone:562-430-3090
Mailing Address - Fax:562-430-3090
Practice Address - Street 1:12535 SEAL BEACH BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-2712
Practice Address - Country:US
Practice Address - Phone:562-430-8850
Practice Address - Fax:562-430-3090
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16514106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist