MEDICARE: LOUIS HAYNIE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner
2	1041C0700X	Clinical Social Worker	8250-C	NV

General Provider Information

NPI Number	:	1902337769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUIS HAYNIE LCSW

Provider Business Mailing Address
First Line	:	6895 E. LAKE MEAD BLVD
Second Line	:	SUITE 6 #200
City	:	LAS VEGAS
State	:	NV
Zip	:	89156-6782
Country	:	US
Telephone Number	:	702-329-4262
Fax Number	:	702-825-0015

Provider Business Practice Location Address
First Line	:	2100 S MARYLAND PKWY STE 5
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3225
Country	:	US
Telephone Number	:	702-329-4262
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2017
Last Update Date	:	08/09/2021

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Directions to “ LOUIS HAYNIE LCSW” Practice Location

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