Provider Demographics
NPI:1558691022
Name:HAYNES, RICHARD GLENN SR (MSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:GLENN
Last Name:HAYNES
Suffix:SR
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HOLIDAY INN PLAZA
Mailing Address - Street 2:SUITE 400 ILLINOIS MENTOR
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2241
Mailing Address - Country:US
Mailing Address - Phone:708-679-9137
Mailing Address - Fax:
Practice Address - Street 1:600 HOLIDAY INN PLAZA
Practice Address - Street 2:SUITE 400 ILLINOIS MENTOR
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2241
Practice Address - Country:US
Practice Address - Phone:708-679-9137
Practice Address - Fax:708-679-6861
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health