Provider Demographics
NPI:1417648544
Name:STEVENS, HALEY RAE (LSW)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:RAE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 HALLADAY ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-1407
Mailing Address - Country:US
Mailing Address - Phone:405-301-3144
Mailing Address - Fax:
Practice Address - Street 1:1525 BROOKHOLLOW DR.
Practice Address - Street 2:SUITE 80
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705
Practice Address - Country:US
Practice Address - Phone:405-301-3144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.1092551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical