Healthcare Provider Details

I. General information

NPI: 1750041455
Provider Name (Legal Business Name): HALEY NICHOLE DEMAREE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 S PACHECO ST STE 500
SANTA FE NM
87505-3994
US

IV. Provider business mailing address

199 FRED TRIMBLE RD UNIT F
DRIFTWOOD TX
78619-2073
US

V. Phone/Fax

Practice location:
  • Phone: 505-209-3939
  • Fax:
Mailing address:
  • Phone: 210-995-1691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2025-0479
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: