Provider Demographics
NPI:1134985666
Name:FAULKNER, HALEY (RBT)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4229 U S HIGHWAY 11
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8024
Mailing Address - Country:US
Mailing Address - Phone:985-855-5632
Mailing Address - Fax:
Practice Address - Street 1:4229 U S HIGHWAY 11
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8024
Practice Address - Country:US
Practice Address - Phone:985-855-5632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS23297989106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician