Healthcare Provider Details

I. General information

NPI: 1538804489
Provider Name (Legal Business Name): HALEY COURTNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 10/30/2022
Certification Date: 10/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 GREEN VISTA DR STE 106
SPARKS NV
89431-8515
US

IV. Provider business mailing address

2125 GREEN VISTA DR STE 106
SPARKS NV
89431-8515
US

V. Phone/Fax

Practice location:
  • Phone: 775-622-8890
  • Fax:
Mailing address:
  • Phone: 775-622-8890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW-92657
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number92657
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number107565
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9949-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: