MEDICARE: HALEY MICHEL LCSW-PIP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6819	SD

General Provider Information

NPI Number	:	1144104969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY MICHEL LCSW-PIP

Provider Business Mailing Address
First Line	:	220 N EVEREST AVE
Second Line	:
City	:	TEA
State	:	SD
Zip	:	57064-2708
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5501 E 18TH ST STE 140
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57110-2829
Country	:	US
Telephone Number	:	605-789-3039
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2025
Last Update Date	:	08/04/2025

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