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General NPI Number Information
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NPI Number | 1790547628
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Entity Type | Individual
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Provider Name | HALEY SHYANNE LURTEN
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Gender | Female
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Dates
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Enumeration Date | 01/25/2024
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 12725 W INDIAN SCHOOL RD BLDG D
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City | AVONDALE
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State | AZ
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Zip | 85392-9520
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Country | US
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Telephone | 623-207-7190
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Fax |
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Provider Business Mailing Address
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Address Line | 1891 N LITCHFIELD RD APT 160
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City | GOODYEAR
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State | AZ
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Zip | 85395-1604
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Country | US
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Telephone | 402-804-0493
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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