Provider Demographics
NPI:1033561105
Name:HAYNES, JESSICA (LPCC, NCC, EMDR)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HAYNES
Suffix:
Gender:F
Credentials:LPCC, NCC, EMDR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 9TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-3277
Mailing Address - Country:US
Mailing Address - Phone:970-980-4188
Mailing Address - Fax:
Practice Address - Street 1:1122 9TH ST STE 201
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-3277
Practice Address - Country:US
Practice Address - Phone:970-980-4188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COO660457Medicaid