Provider Demographics
NPI:1912576786
Name:WILSON, HALEY (MA)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 NW FRANKLIN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-2752
Mailing Address - Country:US
Mailing Address - Phone:541-229-8861
Mailing Address - Fax:
Practice Address - Street 1:731 NW FRANKLIN AVE STE 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2752
Practice Address - Country:US
Practice Address - Phone:541-229-8861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health