Provider Demographics
NPI:1033210125
Name:HAYES, MARK (LMFT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:HAYES
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E COTTON ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-7415
Mailing Address - Country:US
Mailing Address - Phone:903-757-9383
Mailing Address - Fax:903-757-4714
Practice Address - Street 1:110 E COTTON ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-7415
Practice Address - Country:US
Practice Address - Phone:903-757-9383
Practice Address - Fax:903-757-4714
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor