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General NPI Number Information
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NPI Number | 1366070633
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Entity Type | Individual
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Provider Name | WILLIAM CARL HAYNES PSYD
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Gender | Male
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Dates
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Enumeration Date | 03/31/2020
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Last Update Date | 08/18/2020
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Provider Practice Location Address
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Address Line | 2639 MIAMI ST 2 WEST
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City | SAINT LOUIS
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State | MO
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Zip | 63118-3929
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Country | US
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Telephone | 314-558-1112
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Fax |
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Provider Business Mailing Address
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Address Line | 1892 WILLOW OAK DR
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City | SAINT CHARLES
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State | MO
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Zip | 63303-4162
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Country | US
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Telephone | 434-509-5755
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2013040111
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License Number State | MO
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