Provider Demographics
NPI:1275317638
Name:HALLISEY, ROXANNE
Entity Type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:
Last Name:HALLISEY
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 1:446 HARPER RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-6242
Mailing Address - Country:US
Mailing Address - Phone:719-694-9659
Mailing Address - Fax:
Practice Address - Street 1:4721 TROUSDALE DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37220-1322
Practice Address - Country:US
Practice Address - Phone:615-447-8054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health