Provider Demographics
NPI:1144070095
Name:HAYES, TRAVIS JAY (LICSW)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:JAY
Last Name:HAYES
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 HENNEPIN AVE APT H2508
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-1774
Mailing Address - Country:US
Mailing Address - Phone:701-213-9544
Mailing Address - Fax:
Practice Address - Street 1:1150 HENNEPIN AVE APT H2508
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-1774
Practice Address - Country:US
Practice Address - Phone:701-213-9544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN287861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical