Provider Demographics
NPI:1295392637
Name:URIZ, HALEY JULIET
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:JULIET
Last Name:URIZ
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 1:333 ABBOTT ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4485
Mailing Address - Country:US
Mailing Address - Phone:831-225-0989
Mailing Address - Fax:
Practice Address - Street 1:2489 LAKE TAHOE BLVD STE 23
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7739
Practice Address - Country:US
Practice Address - Phone:530-578-3839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF4416559103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst