Provider Demographics
NPI:1245559566
Name:HAYNES, JEFFERY (PHD LPC,LMHC)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:
Last Name:HAYNES
Suffix:
Gender:M
Credentials:PHD LPC,LMHC
Other - Prefix:DR
Other - First Name:JEFFERY
Other - Middle Name:
Other - Last Name:HAYNES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, LPC
Mailing Address - Street 1:121 WEBB DR STE 202
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-3904
Mailing Address - Country:US
Mailing Address - Phone:863-353-9322
Mailing Address - Fax:863-353-2592
Practice Address - Street 1:121 WEBB DR STE 202
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-3904
Practice Address - Country:US
Practice Address - Phone:863-353-9322
Practice Address - Fax:863-353-2592
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8653101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z04F5OtherBLUE CROSS BLUE SHIELD