Provider Demographics
NPI:1992303002
Name:RUST, HALEY RENAE (MFT - T)
Entity type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:RENAE
Last Name:RUST
Suffix:
Gender:F
Credentials:MFT - T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15440 W 65TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66217-9306
Mailing Address - Country:US
Mailing Address - Phone:316-789-5327
Mailing Address - Fax:
Practice Address - Street 1:15440 W 65TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217-9306
Practice Address - Country:US
Practice Address - Phone:316-789-5327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03190-T101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health