Provider Demographics
NPI:1225196116
Name:BRENSDAL, HALEY A (LPC)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:A
Last Name:BRENSDAL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 N SUMMERWIND PL
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-3463
Mailing Address - Country:US
Mailing Address - Phone:208-922-9001
Mailing Address - Fax:208-922-3778
Practice Address - Street 1:1411 MAIN ST STE B-C
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-1712
Practice Address - Country:US
Practice Address - Phone:406-969-5183
Practice Address - Fax:406-281-8308
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-3681101YP2500X
MT12190101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID11661968OtherCAQH