Healthcare Provider Details

I. General information

NPI: 1215742457
Provider Name (Legal Business Name): GABRIEL ROGER HAYSE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18968 W 167TH TER
OLATHE KS
66062-7930
US

IV. Provider business mailing address

18968 W 167TH TER
OLATHE KS
66062-7930
US

V. Phone/Fax

Practice location:
  • Phone: 913-206-8404
  • Fax:
Mailing address:
  • Phone: 913-206-8404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number04905
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: