Provider Demographics
NPI:1912306945
Name:HAYNES, JENNIFER (MHC, MS, LMT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HAYNES
Suffix:
Gender:F
Credentials:MHC, MS, LMT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:MULLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:174 PLEASANT ST APT 2
Mailing Address - Street 2:
Mailing Address - City:HANSON
Mailing Address - State:MA
Mailing Address - Zip Code:02341-1908
Mailing Address - Country:US
Mailing Address - Phone:508-789-0920
Mailing Address - Fax:
Practice Address - Street 1:174 PLEASANT ST APT 2
Practice Address - Street 2:
Practice Address - City:HANSON
Practice Address - State:MA
Practice Address - Zip Code:02341-1908
Practice Address - Country:US
Practice Address - Phone:508-789-0920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227014011171W00000X
225700000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171W00000XOther Service ProvidersContractor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist