Healthcare Provider Details

I. General information

NPI: 1750864500
Provider Name (Legal Business Name): NIKKI HAYNESWORTH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 N SCOTTSDALE RD STE A199
SCOTTSDALE AZ
85253-3593
US

IV. Provider business mailing address

12621 N TATUM BLVD # 1629
PHOENIX AZ
85032-7710
US

V. Phone/Fax

Practice location:
  • Phone: 480-524-0990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number007895
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-21169
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: