MEDICARE: HALEY FICKEL MA, MFT, LPC

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	101YP2500X	Professional Counselor	C.1801424	OH
2	106H00000X	Marriage & Family Therapist	M.1800078	OH

General Provider Information

NPI Number	:	1932683059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY FICKEL MA, MFT, LPC

Provider Business Mailing Address
First Line	:	3070 RIVERSIDE DR STE 160
Second Line	:
City	:	UPPER ARLINGTON
State	:	OH
Zip	:	43221-2547
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3070 RIVERSIDE DR STE 160
Second Line	:
City	:	UPPER ARLINGTON
State	:	OH
Zip	:	43221-2547
Country	:	US
Telephone Number	:	614-721-5066
Fax Number	:

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

Provider Enumeration Date	:	09/25/2018
Last Update Date	:	02/12/2019

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