Healthcare Provider Details

I. General information

NPI: 1902421993
Provider Name (Legal Business Name): HALEY N MELVIN PLMHP, PLCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 N SAINT JOSEPH AVE
HASTINGS NE
68901-4451
US

IV. Provider business mailing address

715 N SAINT JOSEPH AVE
HASTINGS NE
68901-4451
US

V. Phone/Fax

Practice location:
  • Phone: 402-461-5517
  • Fax:
Mailing address:
  • Phone: 402-460-5836
  • Fax: 402-460-5829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12204
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7479
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: