MEDICARE: LAURA JEAN HAYNES

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	106S00000X	Behavior Technician		NV

General Provider Information

NPI Number	:	1831059831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA JEAN HAYNES

Provider Business Mailing Address
First Line	:	3909 SEQUOIA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-1119
Country	:	US
Telephone Number	:	619-288-1373
Fax Number	:	619-288-1373

Provider Business Practice Location Address
First Line	:	1770 N BUFFALO DR STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-2679
Country	:	US
Telephone Number	:	702-514-1222
Fax Number	:

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

Provider Enumeration Date	:	11/13/2025
Last Update Date	:	11/13/2025

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