Healthcare Provider Details

I. General information

NPI: 1457427080
Provider Name (Legal Business Name): DANIEL S HAYES PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2190 W IRONWOOD CENTER DR STE 2
COEUR D ALENE ID
83814-2695
US

IV. Provider business mailing address

2190 W IRONWOOD CENTER DR STE 2
COEUR D ALENE ID
83814-2695
US

V. Phone/Fax

Practice location:
  • Phone: 208-666-0357
  • Fax: 208-666-0468
Mailing address:
  • Phone: 208-666-0357
  • Fax: 208-666-0468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY244
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: