Provider Demographics
NPI:1588413322
Name:HALLORAN, CAYLA
Entity type:Individual
Prefix:
First Name:CAYLA
Middle Name:
Last Name:HALLORAN
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 1:14650 FOLIAGE AVE APT 4209
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-6195
Mailing Address - Country:US
Mailing Address - Phone:612-223-2044
Mailing Address - Fax:
Practice Address - Street 1:17685 JUNIPER PATH STE 303
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-9821
Practice Address - Country:US
Practice Address - Phone:952-214-8959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional