Basic Information
| Provider Information | |||||||||
| NPI: | 1386050714 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAYES | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | MA/ABS BEHAVIORAL SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1014 BURRELL AVE | ||||||||
| Address2: | |||||||||
| City: | LEWISTON | ||||||||
| State: | ID | ||||||||
| PostalCode: | 835015589 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087434558 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1014 BURRELL AVE | ||||||||
| Address2: | |||||||||
| City: | LEWISTON | ||||||||
| State: | NEZ PERCE | ||||||||
| PostalCode: | 83501 | ||||||||
| CountryCode: | UM | ||||||||
| TelephoneNumber: | 2087434558 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2014 | ||||||||
| LastUpdateDate: | 02/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LSW-889 | ID | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.