Provider Demographics
NPI:1043450539
Name:KAYS, TY (LPC)
Entity type:Individual
Prefix:
First Name:TY
Middle Name:
Last Name:KAYS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28081-4332
Mailing Address - Country:US
Mailing Address - Phone:757-943-0694
Mailing Address - Fax:866-828-5520
Practice Address - Street 1:119 WEST AVE
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28081-4332
Practice Address - Country:US
Practice Address - Phone:757-943-0694
Practice Address - Fax:866-828-5520
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004355101YP2500X
NC8080101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4945573Medicaid
NC6104642Medicaid
NC6104642OtherNC HEALTH CHOICE
VAC03714OtherMEDICARE