Provider Demographics
NPI:1861869232
Name:HALEY-MIZE, LEIGH SHANNON (PHD)
Entity type:Individual
Prefix:DR
First Name:LEIGH
Middle Name:SHANNON
Last Name:HALEY-MIZE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 RADIO RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-8993
Mailing Address - Country:US
Mailing Address - Phone:601-606-9227
Mailing Address - Fax:
Practice Address - Street 1:728 RADIO RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-8993
Practice Address - Country:US
Practice Address - Phone:601-606-9227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA120344101103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst