Provider Demographics
NPI:1922684372
Name:HAYES, RICHARD (LCSW, LCAC, LM&FT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:HAYES
Suffix:
Gender:M
Credentials:LCSW, LCAC, LM&FT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 TENNESSEE ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46409-2048
Mailing Address - Country:US
Mailing Address - Phone:219-902-4074
Mailing Address - Fax:
Practice Address - Street 1:4220 TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46409-2048
Practice Address - Country:US
Practice Address - Phone:219-902-4074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001306A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN8911590235OtherOPERATOR LICENSE