Healthcare Provider Details

I. General information

NPI: 1508419847
Provider Name (Legal Business Name): HALEY RENAE KRISS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10335 CEDARCREST RD
WHITMORE LAKE MI
48189-9396
US

IV. Provider business mailing address

315 E MAIN ST PO BOX #115
VERNON MI
48476-9121
US

V. Phone/Fax

Practice location:
  • Phone: 810-207-5725
  • Fax:
Mailing address:
  • Phone: 810-691-3472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150104106
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801120803
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: