Healthcare Provider Details

I. General information

NPI: 1134051410
Provider Name (Legal Business Name): CHRISTOPHER HAYNES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 WESTFORD ST APT 2
LOWELL MA
01851-2769
US

IV. Provider business mailing address

1005 WESTFORD ST APT 2
LOWELL MA
01851-2769
US

V. Phone/Fax

Practice location:
  • Phone: 781-771-1472
  • Fax:
Mailing address:
  • Phone: 781-771-1472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10001084
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: