Healthcare Provider Details

I. General information

NPI: 1871643247
Provider Name (Legal Business Name): BERNADETTE HAYES M.ED., LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 02/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E SUPERIOR ST SUITE 310
CHICAGO IL
60611-2507
US

IV. Provider business mailing address

1 E SUPERIOR ST SUITE 310
CHICAGO IL
60611-2507
US

V. Phone/Fax

Practice location:
  • Phone: 312-485-1215
  • Fax: 312-988-4040
Mailing address:
  • Phone: 312-485-1215
  • Fax: 312-988-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180006318
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: