Provider Demographics
NPI:1124128210
Name:HALEY, GENA RENAI (LPC)
Entity type:Individual
Prefix:
First Name:GENA
Middle Name:RENAI
Last Name:HALEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:GENA
Other - Middle Name:RENAI
Other - Last Name:GREENWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:4358 APACHE PLUME DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7641
Mailing Address - Country:US
Mailing Address - Phone:719-200-0518
Mailing Address - Fax:866-220-4492
Practice Address - Street 1:4358 APACHE PLUME DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7641
Practice Address - Country:US
Practice Address - Phone:719-200-0518
Practice Address - Fax:866-220-4492
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61191484101YM0800X
NY008189101YM0800X
TX16968101YP2500X
CO0014352101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148957701Medicaid
TX6210LCOtherBLUE CROSS/BLUE SHIELD
TX7114677OtherAETNA
TX6210LCOtherBLUE CROSS/BLUE SHIELD