Healthcare Provider Details

I. General information

NPI: 1386295681
Provider Name (Legal Business Name): HALEY LOZANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HALEY CLARK

II. Dates (important events)

Enumeration Date: 09/27/2019
Last Update Date: 08/31/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 ELECTRIC AVENUE
PORT HURON MI
48060
US

IV. Provider business mailing address

3111 ELECTRIC AVENUE
PORT HURON MI
48060
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-8900
  • Fax:
Mailing address:
  • Phone: 810-985-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: