Provider Demographics
NPI:1114207909
Name:ATHERTON, HALEY MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:MARIE
Last Name:ATHERTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14194 SW BARROWS RD
Mailing Address - Street 2:UNIT 3
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223
Mailing Address - Country:US
Mailing Address - Phone:575-640-2119
Mailing Address - Fax:503-640-0334
Practice Address - Street 1:447 SE BASELINE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-4103
Practice Address - Country:US
Practice Address - Phone:503-640-4222
Practice Address - Fax:503-640-0334
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health