Provider Demographics
NPI:1275650087
Name:HAYES, EVERETT CHARLES
Entity Type:Individual
Prefix:DR
First Name:EVERETT
Middle Name:CHARLES
Last Name:HAYES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10910 W WESTPORT ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-6472
Mailing Address - Country:US
Mailing Address - Phone:316-727-9867
Mailing Address - Fax:888-786-6883
Practice Address - Street 1:770 S GREENWICH RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-4314
Practice Address - Country:US
Practice Address - Phone:316-727-9867
Practice Address - Fax:888-786-6883
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS750106H00000X
KS101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200437950BMedicaid