Provider Demographics
NPI:1952974529
Name:COLLETTE, HAILEY (MA, BA)
Entity Type:Individual
Prefix:MISS
First Name:HAILEY
Middle Name:
Last Name:COLLETTE
Suffix:
Gender:F
Credentials:MA, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12252 NW BARNES RD APT 17
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5949
Mailing Address - Country:US
Mailing Address - Phone:406-459-1176
Mailing Address - Fax:
Practice Address - Street 1:110 HATTON AVE APT 202
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-6808
Practice Address - Country:US
Practice Address - Phone:541-344-7303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health