Provider Demographics
NPI:1437390200
Name:HALEY GARRETT, KERRI ELLEN (BCBA)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:ELLEN
Last Name:HALEY GARRETT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:ELLEN
Other - Last Name:HALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:PO BOX 1081
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-1081
Mailing Address - Country:US
Mailing Address - Phone:727-452-7500
Mailing Address - Fax:
Practice Address - Street 1:11515 BATHGATE CT
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-4586
Practice Address - Country:US
Practice Address - Phone:727-452-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-07-3301103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst