Healthcare Provider Details

I. General information

NPI: 1760313290
Provider Name (Legal Business Name): HALEY EKSTROM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HALEY FELDER

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N DILLARD ST STE 103
WINTER GARDEN FL
34787-2853
US

IV. Provider business mailing address

410 N DILLARD ST STE 103
WINTER GARDEN FL
34787-2853
US

V. Phone/Fax

Practice location:
  • Phone: 407-654-5700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: