=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275882664
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KATIE HAYEN LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2012
-----------------------------------------------------
Last Update Date | 08/31/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3855 S. BOULVARD STE. 100
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-340-4321
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 707 SE 26TH STREET
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-650-9769
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. KATHRYN R HAYDEN
-----------------------------------------------------
Credential | LCSW, LADC
-----------------------------------------------------
Telephone | 405-650-9769
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 633
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 3473
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------