Provider Demographics
NPI:1285186890
Name:HAYES, JERRILYN (LMSW-IPR)
Entity Type:Individual
Prefix:
First Name:JERRILYN
Middle Name:
Last Name:HAYES
Suffix:
Gender:F
Credentials:LMSW-IPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14405 WALTERS RD STE 948
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-1493
Mailing Address - Country:US
Mailing Address - Phone:281-272-2206
Mailing Address - Fax:
Practice Address - Street 1:14405 WALTERS RD
Practice Address - Street 2:SUITE 948
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-1337
Practice Address - Country:US
Practice Address - Phone:281-272-2206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-30
Last Update Date:2017-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33621104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker