# HALEIGH BOUSLOG LMHC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780571224
- **Authorized official:** HALEIGH BOUSLOG (LMHC, OWNER)
- **Authorized official phone:** (605) 359-1840

## Contact information

- **Practice address:** 12345 UNIVERSITY AVE STE 310, CLIVE, IA 50325-8285
- **Practice address phone:** (515) 329-0213
- **Mailing address:** 12345 UNIVERSITY AVE STE 310, CLIVE, IA 50325-8285

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |

## Other

- **Enumeration date:** 06/18/2025
- **Last updated:** 06/18/2025