Provider Demographics
NPI:1982920914
Name:HAYES, KEITH JAMES (LMSW)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:JAMES
Last Name:HAYES
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:KEITH
Other - Middle Name:JAMES
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:3100 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2448
Mailing Address - Country:US
Mailing Address - Phone:816-753-2007
Mailing Address - Fax:
Practice Address - Street 1:3100 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2658
Practice Address - Country:US
Practice Address - Phone:816-753-2007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6460101YM0800X
MO2013012337101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health