Provider Demographics
NPI:1396070058
Name:HALEY, TERRI LYNN I (MFT)
Entity type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:LYNN
Last Name:HALEY
Suffix:I
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6684 HARVARD DR
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-5121
Mailing Address - Country:US
Mailing Address - Phone:707-523-9066
Mailing Address - Fax:
Practice Address - Street 1:5213 EL MERCADO PKWY STE A
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1301
Practice Address - Country:US
Practice Address - Phone:707-523-9066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT3374101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health