Basic Information
| Provider Information | |||||||||
| NPI: | 1679691935 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAAG | ||||||||
| FirstName: | LOLA | ||||||||
| MiddleName: | JEANNE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M. S., M. F. T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1336 CRUZERO ST | ||||||||
| Address2: | |||||||||
| City: | OJAI | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930233821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056464611 | ||||||||
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| Practice Location | |||||||||
| Address1: | 975 FLYNN RD | ||||||||
| Address2: | |||||||||
| City: | CAMARILLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930128704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053887740 | ||||||||
| FaxNumber: | 8054820973 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 35117 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.