Provider Demographics
NPI:1962066621
Name:HALEY, JONATHON ROBERT (LCSW)
Entity type:Individual
Prefix:
First Name:JONATHON
Middle Name:ROBERT
Last Name:HALEY
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7515 FALCON CREST DR # 200
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-5014
Mailing Address - Country:US
Mailing Address - Phone:541-904-5216
Mailing Address - Fax:541-527-4347
Practice Address - Street 1:7515 FALCON CREST DR # 200
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-5014
Practice Address - Country:US
Practice Address - Phone:541-904-5216
Practice Address - Fax:541-527-4347
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL132151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical