Provider Demographics
NPI:1649645136
Name:HAYNES, JORDAN
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:HAYNES
Suffix:
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 1:318 N FOREST PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5127
Mailing Address - Country:US
Mailing Address - Phone:652-632-2200
Mailing Address - Fax:865-263-2300
Practice Address - Street 1:318 N FOREST PARK BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5127
Practice Address - Country:US
Practice Address - Phone:865-263-2200
Practice Address - Fax:865-263-2300
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor