Provider Demographics
NPI:1023860707
Name:SPORT PSYCHOLOGY BY CARRIE HASTINGS
Entity type:Organization
Organization Name:SPORT PSYCHOLOGY BY CARRIE HASTINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HASTINGS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:805-242-5771
Mailing Address - Street 1:660 HAMPSHIRE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2549
Mailing Address - Country:US
Mailing Address - Phone:805-242-5771
Mailing Address - Fax:805-242-2829
Practice Address - Street 1:660 HAMPSHIRE RD STE 100
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2549
Practice Address - Country:US
Practice Address - Phone:805-242-5771
Practice Address - Fax:805-242-2829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty