Provider Demographics
NPI:1811030836
Name:HAYGOOD, BEN THOMAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:THOMAS
Last Name:HAYGOOD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2495 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LINDALE
Mailing Address - State:TX
Mailing Address - Zip Code:75771-7704
Mailing Address - Country:US
Mailing Address - Phone:903-570-9306
Mailing Address - Fax:903-882-8810
Practice Address - Street 1:2495 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-7704
Practice Address - Country:US
Practice Address - Phone:903-570-9306
Practice Address - Fax:903-882-8810
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6639101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional