Basic Information
| Provider Information | |||||||||
| NPI: | 1225426174 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAXWELL | ||||||||
| FirstName: | HAYLEY | ||||||||
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| Credential: | MA, LADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 143RD ST W | ||||||||
| Address2: | |||||||||
| City: | ROSEMOUNT | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550684013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5072619534 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1700 UNIVERSITY AVE W FL 6 | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551043727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512322273 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2014 | ||||||||
| LastUpdateDate: | 06/19/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.