Provider Demographics
NPI:1710463344
Name:HAILEY, TERRI ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:ANN
Last Name:HAILEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:TERRI
Other - Middle Name:ANN
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2509 RESEARCH BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-8108
Mailing Address - Country:US
Mailing Address - Phone:307-509-9627
Mailing Address - Fax:970-407-7440
Practice Address - Street 1:2509 RESEARCH BLVD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-8108
Practice Address - Country:US
Practice Address - Phone:307-509-9627
Practice Address - Fax:970-407-7440
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099237531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical