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General NPI Number Information
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NPI Number | 1770930992
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Entity Type | Individual
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Provider Name | LIN TERESA HALEY LMFT LPCC
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Gender | Female
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Dates
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Enumeration Date | 05/17/2016
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Last Update Date | 04/14/2020
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Provider Practice Location Address
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Address Line | 1151 BROADWAY STE 103
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City | SONOMA
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State | CA
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Zip | 95476-7583
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Country | US
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Telephone | 707-318-0566
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 285
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City | GLEN ELLEN
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State | CA
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Zip | 95442-0285
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Country | US
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Telephone | 707-318-0566
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 92501
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License Number State | CA
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