Provider Demographics
NPI:1104969385
Name:HAYES, MARK A (PSY D)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:HAYES
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 S PARSONS AVE
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-5212
Mailing Address - Country:US
Mailing Address - Phone:813-657-7754
Mailing Address - Fax:813-684-6887
Practice Address - Street 1:2204 S PARSONS AVE
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-5212
Practice Address - Country:US
Practice Address - Phone:813-657-7754
Practice Address - Fax:813-684-6887
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6891103T00000X, 103TA0400X, 103TC0700X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily