Provider Demographics
NPI:1023116738
Name:HALLER, SUE ANN (LCSW LMFT)
Entity type:Individual
Prefix:MRS
First Name:SUE
Middle Name:ANN
Last Name:HALLER
Suffix:
Gender:F
Credentials:LCSW LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6674 E DALLAS DR
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802
Mailing Address - Country:US
Mailing Address - Phone:812-234-0448
Mailing Address - Fax:812-234-6614
Practice Address - Street 1:4733 S 7TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802
Practice Address - Country:US
Practice Address - Phone:812-234-0448
Practice Address - Fax:812-234-6614
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002365A1041C0700X
IN35001126A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
157281OtherMANAGED HEALTH NETWORK
352064811001OtherEMPIRE BCBS
35206481101OtherBCBS FED EMPLOYEES
000000183047OtherANTHEM
402700OtherVALUE OPTIONS
1049908OtherCIGNA BEHAVIORAL
5431692OtherAETNA
402700OtherVALUE OPTIONS