Provider Demographics
NPI:1215594197
Name:HAYES, AMY COLLEEN (MA, NCC, LPCC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:COLLEEN
Last Name:HAYES
Suffix:
Gender:F
Credentials:MA, NCC, LPCC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:C
Other - Last Name:O'BRYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, NCC, LPCC
Mailing Address - Street 1:4897 MILLER TRUNK HWY STE 221
Mailing Address - Street 2:
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1936
Mailing Address - Country:US
Mailing Address - Phone:218-319-7171
Mailing Address - Fax:
Practice Address - Street 1:4897 MILLER TRUNK HWY STE 221
Practice Address - Street 2:
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811-1936
Practice Address - Country:US
Practice Address - Phone:218-319-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-25
Last Update Date:2019-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1640101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional