Provider Demographics
NPI:1427162734
Name:HAYES, EMMELINE (LMHC)
Entity type:Individual
Prefix:
First Name:EMMELINE
Middle Name:
Last Name:HAYES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SIMONE WAY
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-7750
Mailing Address - Country:US
Mailing Address - Phone:904-829-1770
Mailing Address - Fax:904-825-0604
Practice Address - Street 1:201 SIMONE WAY
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-7750
Practice Address - Country:US
Practice Address - Phone:904-829-1770
Practice Address - Fax:904-825-0604
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4504101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH4504OtherSTATE LICENSE NUMBER