Provider Demographics
NPI:1598651424
Name:HAYES, TERESA KELLY (LMSW)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:KELLY
Last Name:HAYES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30484 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-1554
Mailing Address - Country:US
Mailing Address - Phone:206-501-1289
Mailing Address - Fax:
Practice Address - Street 1:29201 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1331
Practice Address - Country:US
Practice Address - Phone:833-940-2763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801102325101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor