Provider Demographics
NPI:1336670439
Name:HAYS, MARY ELLEN S (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MARY ELLEN
Middle Name:S
Last Name:HAYS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:EMMY
Other - Middle Name:
Other - Last Name:HAYS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1560 EAGLE POINT DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-5448
Mailing Address - Country:US
Mailing Address - Phone:928-273-8787
Mailing Address - Fax:
Practice Address - Street 1:1560 EAGLE POINT DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-5448
Practice Address - Country:US
Practice Address - Phone:928-273-8787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-155091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical