Basic Information
| Provider Information | |||||||||
| NPI: | 1235758848 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAYES | ||||||||
| FirstName: | PENNY | ||||||||
| MiddleName: | MARIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2629 MYRTLE ST | ||||||||
| Address2: | |||||||||
| City: | LIVE OAK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959532023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308202966 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 D ST STE G | ||||||||
| Address2: | |||||||||
| City: | MARYSVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959015957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5307427747 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2020 | ||||||||
| LastUpdateDate: | 04/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.