Provider Demographics
NPI:1427838986
Name:SMITH, HALEY MARIE
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 109
Mailing Address - Street 2:
Mailing Address - City:TREMONT CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45372-0109
Mailing Address - Country:US
Mailing Address - Phone:937-536-5891
Mailing Address - Fax:
Practice Address - Street 1:2522 NUTTER PARK DR
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-3500
Practice Address - Country:US
Practice Address - Phone:859-282-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty