MEDICARE: SHANE HALEY LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor	C8002	OR

General Provider Information

NPI Number	:	1144822271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANE HALEY LPC

Provider Business Mailing Address
First Line	:	388 STATE ST STE 348
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-3866
Country	:	US
Telephone Number	:	503-877-5102
Fax Number	:

Provider Business Practice Location Address
First Line	:	388 STATE ST STE 348
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-3866
Country	:	US
Telephone Number	:	503-877-5102
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2020
Last Update Date	:	03/08/2024

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Directions to “ SHANE HALEY LPC” Practice Location

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