Healthcare Provider Details

I. General information

NPI: 1568514222
Provider Name (Legal Business Name): LOVELL C HAYES LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 EXECUTIVE DR
JACKSON TN
38305-2306
US

IV. Provider business mailing address

203 BEDFORD WHITE RD
JACKSON TN
38305-9504
US

V. Phone/Fax

Practice location:
  • Phone: 731-668-9698
  • Fax: 731-668-9658
Mailing address:
  • Phone: 731-422-6245
  • Fax: 731-422-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC0000000823
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: