Basic Information
| Provider Information | |||||||||
| NPI: | 1619481694 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANTANA | ||||||||
| FirstName: | HALLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2945 LAKEHOUSE COVE ISLE APT 204 | ||||||||
| Address2: | |||||||||
| City: | PLANT CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335667421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137674594 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1373 OVERLEA DR | ||||||||
| Address2: | |||||||||
| City: | DUNEDIN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346984748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274925369 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2017 | ||||||||
| LastUpdateDate: | 01/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106E00000X | N | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.