Basic Information
| Provider Information | |||||||||
| NPI: | 1447380043 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAYES | ||||||||
| FirstName: | SHAWN | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3840 EVERGREEN AVE | ||||||||
| Address2: | |||||||||
| City: | DEPOE BAY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973419704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417642682 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4466 NE DEVILS LAKE BLVD STE B | ||||||||
| Address2: | |||||||||
| City: | LINCOLN CITY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973675197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419941741 | ||||||||
| FaxNumber: | 5419941882 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | X | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | X | Behavioral Health & Social Service Providers | Counselor | Professional | 106H00000X | X | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.