Provider Demographics
NPI:1750631214
Name:WALTZ, HAYLEY (CERTIFIED COUNSELOR)
Entity Type:Individual
Prefix:MRS
First Name:HAYLEY
Middle Name:
Last Name:WALTZ
Suffix:
Gender:F
Credentials:CERTIFIED COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16625 35TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98155-5445
Mailing Address - Country:US
Mailing Address - Phone:206-931-8143
Mailing Address - Fax:
Practice Address - Street 1:2500 116TH AVE NE STE 1
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1435
Practice Address - Country:US
Practice Address - Phone:206-931-8143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL60169063101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor