Provider Demographics
NPI:1174037600
Name:REED, HAILEY BROOKE (LPC)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:BROOKE
Last Name:REED
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:HAILEY
Other - Middle Name:BROOKE
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 E CENTER ST STE B
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-6352
Mailing Address - Country:US
Mailing Address - Phone:208-234-2600
Mailing Address - Fax:208-234-2800
Practice Address - Street 1:210 E CENTER ST STE B
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-6352
Practice Address - Country:US
Practice Address - Phone:208-234-2600
Practice Address - Fax:208-234-2800
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6601101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health