Healthcare Provider Details

I. General information

NPI: 1982920914
Provider Name (Legal Business Name): KEITH JAMES HAYES LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KEITH JAMES HAYES LMSW

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 BROADWAY ST
KANSAS CITY MO
64111-2658
US

IV. Provider business mailing address

3100 BROADWAY
KANSAS CITY MO
64111-2448
US

V. Phone/Fax

Practice location:
  • Phone: 816-753-2007
  • Fax:
Mailing address:
  • Phone: 816-753-2007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6460
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2013012337
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: