Healthcare Provider Details

I. General information

NPI: 1679758650
Provider Name (Legal Business Name): PATRICIA J. HAYES, PSY.D ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 W ELMWOOD DR SUITE 202
CENTERVILLE OH
45459-4239
US

IV. Provider business mailing address

77 W ELMWOOD DR SUITE 202
CENTERVILLE OH
45459-4239
US

V. Phone/Fax

Practice location:
  • Phone: 937-436-0700
  • Fax: 937-424-5749
Mailing address:
  • Phone: 937-436-0700
  • Fax: 937-424-5749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4580
License Number StateOH

VIII. Authorized Official

Name: PATRICIA J HAYES
Title or Position: SOLE PROPRIETOR
Credential: PSY.D.
Phone: 937-436-0700