Provider Demographics
NPI:1235305392
Name:HAYNES, SUZANNE M (MS)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:HAYNES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36700 WOODWARD AVE
Mailing Address - Street 2:SUITE 30
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-0926
Mailing Address - Country:US
Mailing Address - Phone:248-470-9615
Mailing Address - Fax:
Practice Address - Street 1:36700 WOODWARD AVE
Practice Address - Street 2:SUITE 30
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-0926
Practice Address - Country:US
Practice Address - Phone:248-470-9615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006854103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist