Provider Demographics
NPI:1396264107
Name:HAYES, LISA REBECCA
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:REBECCA
Last Name:HAYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 CANDLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71119-6303
Mailing Address - Country:US
Mailing Address - Phone:318-426-1729
Mailing Address - Fax:
Practice Address - Street 1:2924 KNIGHT ST STE 2924
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2415
Practice Address - Country:US
Practice Address - Phone:318-754-3560
Practice Address - Fax:318-779-0439
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator