Provider Demographics
NPI:1265906176
Name:HAYNES, MONTRICE M (PLPC)
Entity type:Individual
Prefix:
First Name:MONTRICE
Middle Name:M
Last Name:HAYNES
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 CHALMETTE DR
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-3532
Mailing Address - Country:US
Mailing Address - Phone:314-518-2273
Mailing Address - Fax:
Practice Address - Street 1:500 MEDICAL DR.
Practice Address - Street 2:CENTRAL INTAKE
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385
Practice Address - Country:US
Practice Address - Phone:314-344-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health