Provider Demographics
NPI:1194120162
Name:HAYS, AUDRA CARRIE (LCSW)
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:CARRIE
Last Name:HAYS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 W DIDIER AVE
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002-3160
Mailing Address - Country:US
Mailing Address - Phone:505-312-0040
Mailing Address - Fax:
Practice Address - Street 1:838 W DIDIER AVE
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-3160
Practice Address - Country:US
Practice Address - Phone:505-312-0040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-03
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-08380261QM0855X
NMSWB-2024-01141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health