Individual provider · NPI-1

David Hayes Jr.

Contractor · Glendale, AZ

NPI number1457061913

StatusActive

Last updated in NPPESNov 24, 2022

Details

NPI: 1457061913
Entity type: Individual (NPI-1)
Name: David Hayes Jr.
Sex: Male
Sole proprietor: Yes
Enumeration date: Nov 24, 2022
Certification date: Nov 24, 2022
Last updated: Nov 24, 2022

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
171W00000X	Contractor	–	–	Yes
101YM0800X	Counselor, Mental Health	–	AZ
106S00000X	Behavior Technician	–	–
171400000X	Health & Wellness Coach	–	AZ
172V00000X	Community Health Worker	–	–
174200000X	Meals	–	–
343900000X	Non-emergency Medical Transport (VAN)	D06541279	AZ

Practice location

5038 N 55th Ave Apt 2003
Glendale, AZ 85301-7559

Phone 623-419-9045

Mailing address

5038 N 55th Ave Apt 2003
Glendale, AZ 85301-7559

Phone 623-419-9045

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