Provider Demographics
NPI:1710181946
Name:CONNIE HALEY, PC
Entity Type:Organization
Organization Name:CONNIE HALEY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-538-1958
Mailing Address - Street 1:5665 W MAPLE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3741
Mailing Address - Country:US
Mailing Address - Phone:248-538-1958
Mailing Address - Fax:248-626-8836
Practice Address - Street 1:5665 W MAPLE RD
Practice Address - Street 2:SUITE A
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3741
Practice Address - Country:US
Practice Address - Phone:248-538-1958
Practice Address - Fax:248-626-8836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006010103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1720016645OtherNPI TYPE 1
MI1720016645OtherNPI TYPE 1
MI=========OtherEIN