Provider Demographics
NPI:1568978955
Name:TELGEN, HALEY MARIE (BCBA)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:MARIE
Last Name:TELGEN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 TELEGRAPH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1310
Mailing Address - Country:US
Mailing Address - Phone:510-407-8264
Mailing Address - Fax:
Practice Address - Street 1:6001 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1310
Practice Address - Country:US
Practice Address - Phone:510-407-8264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1-21-48381103K00000X
HI16-24238106S00000X
CA1-21-48381103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician