Provider Demographics
NPI:1003157025
Name:HAYS, MONTY D (LPC)
Entity Type:Individual
Prefix:
First Name:MONTY
Middle Name:D
Last Name:HAYS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S ALMON ST APT 214
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-3128
Mailing Address - Country:US
Mailing Address - Phone:208-882-3504
Mailing Address - Fax:
Practice Address - Street 1:200 S ALMON ST APT 214
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3128
Practice Address - Country:US
Practice Address - Phone:208-878-2350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-2926101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1356677765Medicaid