Provider Demographics
NPI:1043816390
Name:HAYDEN, JESSICA (LMHCA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HAYDEN
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 SHIRLEY AVE
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-1544
Mailing Address - Country:US
Mailing Address - Phone:502-381-6454
Mailing Address - Fax:
Practice Address - Street 1:254 SHIRLEY AVE
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-1544
Practice Address - Country:US
Practice Address - Phone:502-381-6454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99100618A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health