Provider Demographics
NPI:1144381898
Name:HATHERILL, DAVID PAUL (PHD LMFT)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PAUL
Last Name:HATHERILL
Suffix:
Gender:M
Credentials:PHD LMFT
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:HATHERILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:P O BOX 867
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-0867
Mailing Address - Country:US
Mailing Address - Phone:619-772-3283
Mailing Address - Fax:858-523-1442
Practice Address - Street 1:2120 THIBODO CT
Practice Address - Street 2:SUITE 230
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92085
Practice Address - Country:US
Practice Address - Phone:858-279-1223
Practice Address - Fax:760-597-4880
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7249103TC0700X
CAMFC 17362106H00000X
MI4101006345106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist