MEDICARE: MR. JARRED LANDON HAYES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	A15860	NC
2	101YM0800X	Mental Health Counselor	A15860	NC

General Provider Information

NPI Number	:	1154935740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JARRED LANDON HAYES

Provider Business Mailing Address
First Line	:	PO BOX 241981
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28224-1981
Country	:	US
Telephone Number	:	980-500-9342
Fax Number	:

Provider Business Practice Location Address
First Line	:	3646 CENTRAL AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-6064
Country	:	US
Telephone Number	:	704-733-9934
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2020
Last Update Date	:	09/01/2020

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