Provider Demographics
NPI:1407910128
Name:HALEY, D. RANDALL (PHD)
Entity Type:Individual
Prefix:DR
First Name:D.
Middle Name:RANDALL
Last Name:HALEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9128 HWY 1 S
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457
Mailing Address - Country:US
Mailing Address - Phone:318-481-3067
Mailing Address - Fax:318-357-6782
Practice Address - Street 1:122 TOULINE ST
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-4685
Practice Address - Country:US
Practice Address - Phone:318-481-3067
Practice Address - Fax:318-357-6782
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA37591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical