Individual provider Active NPI

Jeanne B. Haislett, PH.D.

  • Clinical Child & Adolescent Psychologist
  • Tustin, CA
National Provider Identifier
1114974458
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
PSY 12937 Issued in CA
Practice address
17401 Irvine Blvd
Suite a
Tustin, CA 92780-3038
Phone
(714) 544-2366
Fax
(562) 431-1138
NPI assigned
May 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY 12937 CA
Clinical Child & Adolescent Psychologist 103TC2200X PSY 12937 CA Primary

Addresses

Primary practice location

17401 Irvine Blvd
Suite a
Tustin, CA 92780-3038

Mailing address

PO Box 3640
Seal Beach, CA 90740-7640
Phone (714) 544-2366

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY 12937CAMDClinical Psychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1114974458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3640",
            "city": "SEAL BEACH",
            "state": "CA",
            "postal_code": "907407640",
            "telephone_number": "714-544-2366",
            "fax_number": "562-431-1138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17401 IRVINE BLVD",
            "address_2": "SUITE A",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927803038",
            "telephone_number": "714-544-2366",
            "fax_number": "562-431-1138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAISLETT",
        "first_name": "JEANNE",
        "middle_name": "B.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-30",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 12937",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "CA",
            "license": "PSY 12937",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.