Provider Demographics
NPI:1588155998
Name:HAILS, JUDITH ARLENE (MFT)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ARLENE
Last Name:HAILS
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 1:18240 ARCHES CT
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6802
Mailing Address - Country:US
Mailing Address - Phone:714-206-2889
Mailing Address - Fax:
Practice Address - Street 1:16052 BEACH BLVD STE 218
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3809
Practice Address - Country:US
Practice Address - Phone:714-206-2889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104673106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty