Provider Demographics
NPI:1366536500
Name:HALY, SUSAN L (LMFT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:L
Last Name:HALY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 FOOTHILL BLVD SUITE #105
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750
Mailing Address - Country:US
Mailing Address - Phone:909-593-5111
Mailing Address - Fax:909-593-6111
Practice Address - Street 1:2120 FOOTHILL BLVD
Practice Address - Street 2:STE 105
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750
Practice Address - Country:US
Practice Address - Phone:909-593-5111
Practice Address - Fax:909-593-6111
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38992106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist