Provider Demographics
NPI:1073190880
Name:HAYLES, NICOLE M (LPC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:HAYLES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21613 W 98TH TER
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66220-2686
Mailing Address - Country:US
Mailing Address - Phone:913-488-1849
Mailing Address - Fax:
Practice Address - Street 1:8080 WARD PKWY STE 405
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-2020
Practice Address - Country:US
Practice Address - Phone:816-945-2277
Practice Address - Fax:816-895-3975
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017011428101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional