Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PY6891 | FL |
N | 103T00000X | Psychologist | PY6891 | FL |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PY6891 | FL |
Y | 103G00000X | Clinical Psychologist | PY6891 | FL |
Y | 103TC0700X | Clinical Psychologist | PY6891 | FL |
N | 103TF0000X | Family Psychologist | PY6891 | FL |
NPI | 1104969385 |
---|---|
Provider Name | Mark A Hayes |
First Address | Seffner, FL 33584-5212 |
Second Address | Seffner, FL 33584-5212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 28/12/2007 |