Provider Demographics
NPI:1467548123
Name:HAYNES, SHELLI LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHELLI
Middle Name:LYNN
Last Name:HAYNES
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 1:63417 LEDGESTONE CT
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7723
Mailing Address - Country:US
Mailing Address - Phone:585-233-4100
Mailing Address - Fax:
Practice Address - Street 1:1707 SW PARKWAY DR
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2581
Practice Address - Country:US
Practice Address - Phone:585-624-1350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0523341041C0700X
ORL42791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical