Provider Demographics
NPI:1245617893
Name:SHELLY D. HAIG
Entity Type:Organization
Organization Name:SHELLY D. HAIG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SKILLBUILDER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIG
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:541-484-4428
Mailing Address - Street 1:260 E 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3247
Mailing Address - Country:US
Mailing Address - Phone:541-484-4428
Mailing Address - Fax:541-484-7212
Practice Address - Street 1:260 E 11TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3247
Practice Address - Country:US
Practice Address - Phone:541-484-4428
Practice Address - Fax:541-484-7212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty