| Connie Haley, Pc | |
|
5665 W Maple Rd Suite A West Bloomfield MI 48322-3741 | |
| (248) 538-1958 | |
| (248) 626-8836 |
| Full Name | Connie Haley, Pc |
|---|---|
| Speciality | Psychologist |
| Location | 5665 W Maple Rd, West Bloomfield, Michigan |
| Authorized Official Name and Position | Connie Kay Haley (PRESIDENT) |
| Authorized Official Contact | 2485381958 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Connie Haley, Pc 5665 W Maple Rd Suite A West Bloomfield MI 48322-3741 Ph: (248) 538-1958 | Connie Haley, Pc 5665 W Maple Rd Suite A West Bloomfield MI 48322-3741 Ph: (248) 538-1958 |
| NPI Number | 1710181946 |
|---|---|
| Provider Enumeration Date | 06/12/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 2567450612 |
|---|---|
| Medicare Enrollment ID | O20040505001415 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710181946 | NPI | - | NPPES |
| 1720016645 | Other | MI | NPI TYPE 1 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 6301006010 (Michigan) | Primary |
| Provider Name | Connie Kay Haley |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1720016645 PECOS PAC ID: 2163410218 Enrollment ID: I20040507000439 |
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