Provider Demographics
NPI:1528409406
Name:MAYNARD, HAYLEE A (LMFT)
Entity Type:Individual
Prefix:
First Name:HAYLEE
Middle Name:A
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:HAYLEE
Other - Middle Name:A
Other - Last Name:GROVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9401 SOUTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1407
Mailing Address - Country:US
Mailing Address - Phone:713-970-3800
Mailing Address - Fax:
Practice Address - Street 1:2495 W MARCH LN
Practice Address - Street 2:#125
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-8251
Practice Address - Country:US
Practice Address - Phone:209-465-1080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202712106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist