Provider Demographics
NPI:1891439444
Name:HAYNES, CLIFFORD III
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:
Last Name:HAYNES
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 N RANCHO DR STE 106
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3153
Mailing Address - Country:US
Mailing Address - Phone:213-618-1916
Mailing Address - Fax:
Practice Address - Street 1:3620 N RANCHO DR STE 106
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3153
Practice Address - Country:US
Practice Address - Phone:702-969-5933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral