Provider Demographics
NPI:1972120228
Name:HOLDER, HALEY SONORA (BS)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:SONORA
Last Name:HOLDER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 N MARKET AVE
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-5845
Mailing Address - Country:US
Mailing Address - Phone:405-558-1060
Mailing Address - Fax:
Practice Address - Street 1:301 W 4TH ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-3411
Practice Address - Country:US
Practice Address - Phone:580-436-2690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator