Provider Demographics
NPI:1972684934
Name:HAILLEY, ZAADA (PHD-IMD)
Entity Type:Individual
Prefix:DR
First Name:ZAADA
Middle Name:
Last Name:HAILLEY
Suffix:
Gender:F
Credentials:PHD-IMD
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:LLANES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LMFT, CEAP
Mailing Address - Street 1:407 COLORADO DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR CREEK
Mailing Address - State:TX
Mailing Address - Zip Code:78612-3556
Mailing Address - Country:US
Mailing Address - Phone:512-297-4696
Mailing Address - Fax:512-321-4300
Practice Address - Street 1:407 COLORADO DR.
Practice Address - Street 2:
Practice Address - City:CEDAR CREEK
Practice Address - State:TX
Practice Address - Zip Code:78612-3556
Practice Address - Country:US
Practice Address - Phone:512-297-4696
Practice Address - Fax:512-321-4300
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11255101YP2500X
133N00000X, 133NN1002X
HI462175F00000X
TX003289106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145988501Medicaid
TX095265702Medicaid
TX84840LOtherBCBS
TX2154LCOtherBCBS
TX83814LOtherBCBS