Provider Demographics
NPI:1821293200
Name:HALLADAY, MICHELLE M (MS, LIMHP, LADC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:HALLADAY
Suffix:
Gender:F
Credentials:MS, LIMHP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 355
Mailing Address - Street 2:
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-0355
Mailing Address - Country:US
Mailing Address - Phone:402-494-3337
Mailing Address - Fax:402-494-3356
Practice Address - Street 1:1201 ARBOR DRIVE
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-2652
Practice Address - Country:US
Practice Address - Phone:402-949-3337
Practice Address - Fax:402-494-3356
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE886101YA0400X
NE1111101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47083066226Medicaid