Provider Demographics
NPI:1841690062
Name:SEAN HALEY LLC
Entity type:Organization
Organization Name:SEAN HALEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP
Authorized Official - Phone:402-330-1537
Mailing Address - Street 1:12728 AUGUSTA AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3754
Mailing Address - Country:US
Mailing Address - Phone:402-330-1537
Mailing Address - Fax:402-330-9331
Practice Address - Street 1:12728 AUGUSTA AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3754
Practice Address - Country:US
Practice Address - Phone:402-330-1537
Practice Address - Fax:402-330-9331
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PSYCHOLOGICAL AND COUNSELING SERVICES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3656101YP2500X
NE1271101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty