Provider Demographics
NPI:1124735485
Name:HAYNIE, INC
Entity type:Organization
Organization Name:HAYNIE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HAYNIE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-258-2763
Mailing Address - Street 1:1200 W APACHE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-3886
Mailing Address - Country:US
Mailing Address - Phone:505-258-2763
Mailing Address - Fax:505-675-2803
Practice Address - Street 1:1200 W APACHE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-3886
Practice Address - Country:US
Practice Address - Phone:505-258-2763
Practice Address - Fax:505-675-2803
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAYNIE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-04
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM32255705Medicaid
NM32255705Medicaid
NM1245574136OtherNPI