Provider Demographics
NPI:1174269153
Name:HANEY, AVERIE
Entity Type:Individual
Prefix:
First Name:AVERIE
Middle Name:
Last Name:HANEY
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 1:3101 NE 171ST AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-8738
Mailing Address - Country:US
Mailing Address - Phone:360-977-8210
Mailing Address - Fax:
Practice Address - Street 1:3101 NE 171ST AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-8738
Practice Address - Country:US
Practice Address - Phone:360-977-8210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician