Provider Demographics
NPI:1174048326
Name:HAYNES, TERRANCE LAMONT
Entity type:Individual
Prefix:
First Name:TERRANCE
Middle Name:LAMONT
Last Name:HAYNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 W OWEN K GARRIOTT RD STE 4C
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-5751
Mailing Address - Country:US
Mailing Address - Phone:580-233-5900
Mailing Address - Fax:580-701-4312
Practice Address - Street 1:1420 W OWEN K GARRIOTT RD STE 4C
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-5751
Practice Address - Country:US
Practice Address - Phone:580-233-5900
Practice Address - Fax:580-701-4312
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator