Provider Demographics
NPI:1013791045
Name:PALOS, HAILEY (AMFT, APCC)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:
Last Name:PALOS
Suffix:
Gender:F
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5098 FOOTHILLS BLVD # 3-134
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-6526
Mailing Address - Country:US
Mailing Address - Phone:916-272-5025
Mailing Address - Fax:
Practice Address - Street 1:5098 FOOTHILLS BLVD # 3-134
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-6526
Practice Address - Country:US
Practice Address - Phone:916-272-5025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA126447106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist