Basic Information
| Provider Information | |||||||||
| NPI: | 1730204835 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAIRE | ||||||||
| FirstName: | JEREMY | ||||||||
| MiddleName: | CLAYTON | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.S., ED.S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4577 W 3RD ST | ||||||||
| Address2: | |||||||||
| City: | WEST LEBANON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479918089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123711537 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 701 N ENGLEWOOD DR | ||||||||
| Address2: | |||||||||
| City: | CRAWFORDSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479339744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7653619767 | ||||||||
| FaxNumber: | 7653610374 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 11/08/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 39001953A | IN | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.