Provider Demographics
NPI:1265753297
Name:HAYWARD, CANDACE (MSW)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:HAYWARD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13355 S 4410 RD
Mailing Address - Street 2:
Mailing Address - City:BLUEJACKET
Mailing Address - State:OK
Mailing Address - Zip Code:74333-4348
Mailing Address - Country:US
Mailing Address - Phone:918-323-5227
Mailing Address - Fax:
Practice Address - Street 1:30 C ST NE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6316
Practice Address - Country:US
Practice Address - Phone:918-256-7518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK203589520Medicaid