Provider Demographics
NPI:1104027606
Name:HANEY, SETH A (MA, LPC, EMDR)
Entity Type:Individual
Prefix:MR
First Name:SETH
Middle Name:A
Last Name:HANEY
Suffix:
Gender:M
Credentials:MA, LPC, EMDR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WESTWOODS DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-3519
Mailing Address - Country:US
Mailing Address - Phone:816-781-2349
Mailing Address - Fax:816-792-8232
Practice Address - Street 1:20 WESTWOODS DR
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-3519
Practice Address - Country:US
Practice Address - Phone:816-781-2349
Practice Address - Fax:816-792-8232
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007010481101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1669585543Medicaid