Provider Demographics
NPI:1033340062
Name:HAYTER, DAVID LAWRENCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LAWRENCE
Last Name:HAYTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42391 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-1431
Mailing Address - Country:US
Mailing Address - Phone:586-770-7887
Mailing Address - Fax:585-468-8037
Practice Address - Street 1:310 EUCLID ST
Practice Address - Street 2:SUITE 11
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-9702
Practice Address - Country:US
Practice Address - Phone:586-770-7887
Practice Address - Fax:586-468-8037
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-08
Last Update Date:2009-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002238103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical