Provider Demographics
NPI:1073324521
Name:BLEEKER, HALAYNA GRACE
Entity type:Individual
Prefix:
First Name:HALAYNA
Middle Name:GRACE
Last Name:BLEEKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:674 DEESE RD
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360-2518
Mailing Address - Country:US
Mailing Address - Phone:334-464-0530
Mailing Address - Fax:
Practice Address - Street 1:807 DONNELL BLVD
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36322-2104
Practice Address - Country:US
Practice Address - Phone:334-709-4024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician