Provider Demographics
NPI:1144434200
Name:HAYES, MARY JEAN (PHD MFT)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:JEAN
Last Name:HAYES
Suffix:
Gender:F
Credentials:PHD MFT
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:20 BAY TREE HOLLOW
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945
Mailing Address - Country:US
Mailing Address - Phone:415-897-1348
Mailing Address - Fax:928-833-1787
Practice Address - Street 1:1421 GUERNEVILLE ROAD
Practice Address - Street 2:STE 114
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403
Practice Address - Country:US
Practice Address - Phone:707-542-8979
Practice Address - Fax:707-542-8922
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5862106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist