Provider Demographics
NPI:1790568400
Name:HAYDEN, JAN VANN (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:JAN
Middle Name:VANN
Last Name:HAYDEN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MRS
Other - First Name:JAN
Other - Middle Name:VANN
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:45 CAMDEN BYPASS
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AL
Mailing Address - Zip Code:36726
Mailing Address - Country:US
Mailing Address - Phone:334-682-4499
Mailing Address - Fax:334-682-4615
Practice Address - Street 1:1017 MEDICAL CENTER PARKWAY
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701
Practice Address - Country:US
Practice Address - Phone:334-875-2100
Practice Address - Fax:334-418-1412
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLPC03962101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL330000021Medicaid