Provider Demographics
NPI:1831446509
Name:HALEY, REBA (PHD,CAP, RMFT)
Entity type:Individual
Prefix:MS
First Name:REBA
Middle Name:
Last Name:HALEY
Suffix:
Gender:F
Credentials:PHD,CAP, RMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 648
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33595-0648
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:212 S SAINT CLOUD AVE BLDG A
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-3992
Practice Address - Country:US
Practice Address - Phone:813-716-3996
Practice Address - Fax:813-820-3793
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-12
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
FLMH1822101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor