Provider Demographics
NPI:1912520768
Name:HAYCRAFT, JAMES CHARLES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CHARLES
Last Name:HAYCRAFT
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 1:559 CLIFFVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-9189
Mailing Address - Country:US
Mailing Address - Phone:601-832-9902
Mailing Address - Fax:
Practice Address - Street 1:431 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39201-1108
Practice Address - Country:US
Practice Address - Phone:601-949-1949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST0532A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist