Provider Demographics
NPI:1376565572
Name:HAYNES, CARTER JOHN (MA, MFT, PHD)
Entity Type:Individual
Prefix:MR
First Name:CARTER
Middle Name:JOHN
Last Name:HAYNES
Suffix:
Gender:M
Credentials:MA, MFT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 276785
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-6785
Mailing Address - Country:US
Mailing Address - Phone:916-267-1458
Mailing Address - Fax:916-273-5641
Practice Address - Street 1:3336 BRADSHAW RD
Practice Address - Street 2:# 320
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2615
Practice Address - Country:US
Practice Address - Phone:916-267-1458
Practice Address - Fax:916-273-5641
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 35717106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC 35717OtherMFT LICSENSE