Provider Demographics
NPI:1477563724
Name:HAYES, MARY ELAINE (MS)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELAINE
Last Name:HAYES
Suffix:
Gender:F
Credentials:MS
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 703
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-0703
Mailing Address - Country:US
Mailing Address - Phone:316-788-2200
Mailing Address - Fax:316-788-1514
Practice Address - Street 1:425 N BALTIMORE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-1641
Practice Address - Country:US
Practice Address - Phone:316-788-2200
Practice Address - Fax:316-788-1514
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCP #004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health