Healthcare Provider Details

I. General information

NPI: 1619716834
Provider Name (Legal Business Name): STACEY HAYLETT LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 COURT AVE STE 241
DES MOINES IA
50309-2282
US

IV. Provider business mailing address

5902 ASPEN CIR
JOHNSTON IA
50131-2032
US

V. Phone/Fax

Practice location:
  • Phone: 515-901-2974
  • Fax: 844-770-0390
Mailing address:
  • Phone: 515-664-0024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number123958
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: