Provider Demographics
NPI:1528372745
Name:HALEY, NATALIE RAE (MS/MHC)
Entity type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:RAE
Last Name:HALEY
Suffix:
Gender:F
Credentials:MS/MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4375 N MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:ENOCH
Mailing Address - State:UT
Mailing Address - Zip Code:84721-9463
Mailing Address - Country:US
Mailing Address - Phone:435-691-2802
Mailing Address - Fax:
Practice Address - Street 1:4375 N MAPLE LN
Practice Address - Street 2:
Practice Address - City:ENOCH
Practice Address - State:UT
Practice Address - Zip Code:84721-9463
Practice Address - Country:US
Practice Address - Phone:435-691-2802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7365822-6009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional