Provider Demographics
NPI:1346613924
Name:HAWES, DUSTIN JOHN (MSCP, CPC)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:JOHN
Last Name:HAWES
Suffix:
Gender:M
Credentials:MSCP, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2472
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96160-2472
Mailing Address - Country:US
Mailing Address - Phone:907-830-3362
Mailing Address - Fax:
Practice Address - Street 1:65 REGENCY WAY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3423
Practice Address - Country:US
Practice Address - Phone:775-636-7767
Practice Address - Fax:702-830-9741
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1780936435Medicaid