Provider Demographics
NPI:1790547628
Name:LURTEN, HALEY SHYANNE
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:SHYANNE
Last Name:LURTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 N LITCHFIELD RD APT 160
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-1604
Mailing Address - Country:US
Mailing Address - Phone:402-804-0493
Mailing Address - Fax:
Practice Address - Street 1:12725 W INDIAN SCHOOL RD BLDG D
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-9520
Practice Address - Country:US
Practice Address - Phone:623-207-7190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician