Provider Demographics
NPI:1295462539
Name:HAYDEN, DONNELL (CSSP)
Entity type:Individual
Prefix:
First Name:DONNELL
Middle Name:
Last Name:HAYDEN
Suffix:
Gender:M
Credentials:CSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 MCDERMOTT AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75215-3922
Mailing Address - Country:US
Mailing Address - Phone:214-616-8186
Mailing Address - Fax:
Practice Address - Street 1:1111 W MOCKINGBIRD LN # 480
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-5028
Practice Address - Country:US
Practice Address - Phone:214-616-8186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No171M00000XOther Service ProvidersCase Manager/Care Coordinator