Healthcare Provider Details

I. General information

NPI: 1699945303
Provider Name (Legal Business Name): KATHY HOLDER HAYES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 BARNHILL DR
INDIANAPOLIS IN
46202-5128
US

IV. Provider business mailing address

250 N SHADELAND AVE STE 200
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-8162
  • Fax:
Mailing address:
  • Phone: 317-962-4827
  • Fax: 317-948-3078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34001238A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: