Provider Demographics
NPI:1518521681
Name:WALDROP, HAYLEY JO (LPC)
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:JO
Last Name:WALDROP
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1336
Mailing Address - Street 2:ATTN: SHARLA STARITA
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-1185
Mailing Address - Country:US
Mailing Address - Phone:361-777-3991
Mailing Address - Fax:361-777-0610
Practice Address - Street 1:101 W POTTS ST
Practice Address - Street 2:
Practice Address - City:FALFURRIAS
Practice Address - State:TX
Practice Address - Zip Code:78355-4906
Practice Address - Country:US
Practice Address - Phone:361-777-3991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77016101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX77016OtherTEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS