Provider Demographics
NPI:1114754512
Name:THOMPSON, HAILA SELESE
Entity type:Individual
Prefix:
First Name:HAILA
Middle Name:SELESE
Last Name:THOMPSON
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 1:1910 S BURLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47302-3893
Mailing Address - Country:US
Mailing Address - Phone:765-713-2040
Mailing Address - Fax:
Practice Address - Street 1:1910 S BURLINGTON DR
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47302-3893
Practice Address - Country:US
Practice Address - Phone:765-713-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty