Provider Demographics
NPI:1407511603
Name:MILLER-BOREN, HALEY CORRINE (MC61233358)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:CORRINE
Last Name:MILLER-BOREN
Suffix:
Gender:F
Credentials:MC61233358
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11725 NE 106TH LN
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5043
Mailing Address - Country:US
Mailing Address - Phone:805-832-0283
Mailing Address - Fax:
Practice Address - Street 1:195 NE GILMAN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2940
Practice Address - Country:US
Practice Address - Phone:425-295-7697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61233358101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health