Provider Demographics
NPI:1912712423
Name:HAIRSTON, STYRONE SR
Entity type:Individual
Prefix:MR
First Name:STYRONE
Middle Name:
Last Name:HAIRSTON
Suffix:SR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13504 CIELO AZUL WAY
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-6204
Mailing Address - Country:US
Mailing Address - Phone:442-637-9565
Mailing Address - Fax:
Practice Address - Street 1:69930 CA-111,
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270
Practice Address - Country:US
Practice Address - Phone:800-207-0272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent