Provider Demographics
NPI:1073490850
Name:PANGMAN, HALEY ROSS (LMFT)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:ROSS
Last Name:PANGMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 SAN JUAN DR
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4857
Mailing Address - Country:US
Mailing Address - Phone:608-577-5111
Mailing Address - Fax:
Practice Address - Street 1:510 SAN JUAN DR
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4857
Practice Address - Country:US
Practice Address - Phone:608-577-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.0002890106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist