Provider Demographics
NPI:1871757617
Name:HAYES, JAMES MICHAEL (CCDC III)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:HAYES
Suffix:
Gender:M
Credentials:CCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-2917
Mailing Address - Country:US
Mailing Address - Phone:605-996-9033
Mailing Address - Fax:605-996-0840
Practice Address - Street 1:1115 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-2917
Practice Address - Country:US
Practice Address - Phone:605-996-9033
Practice Address - Fax:605-996-0840
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD9607788101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9607788OtherCHEMICAL DEPENDENCY COUNSELOR CERTIFICATION BOARD
F18406OtherCLINICAL FORENSIC COUNSELING