Provider Demographics
NPI:1518686138
Name:HAYNES, DENNIS (LPC)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:HAYNES
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 N SHERIDAN RD APT 13A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-4828
Mailing Address - Country:US
Mailing Address - Phone:309-360-0700
Mailing Address - Fax:
Practice Address - Street 1:2732 N CLARK ST STE 300
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1553
Practice Address - Country:US
Practice Address - Phone:773-250-1769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017930101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional