Provider Demographics
NPI:1235667569
Name:HAYNIE, KIRT BENJAMIN (BS)
Entity Type:Individual
Prefix:
First Name:KIRT
Middle Name:BENJAMIN
Last Name:HAYNIE
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BIG MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:LOVELOCK
Mailing Address - State:NV
Mailing Address - Zip Code:89419-5449
Mailing Address - Country:US
Mailing Address - Phone:801-244-0195
Mailing Address - Fax:
Practice Address - Street 1:100 BIG MEADOW LN
Practice Address - Street 2:
Practice Address - City:LOVELOCK
Practice Address - State:NV
Practice Address - Zip Code:89419-5449
Practice Address - Country:US
Practice Address - Phone:801-244-0195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health