Provider Demographics
NPI:1518408012
Name:TIBBITS, HALEY (MA, AAC, MHP)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:TIBBITS
Suffix:
Gender:F
Credentials:MA, AAC, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1458 RUSH RD
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-8727
Mailing Address - Country:US
Mailing Address - Phone:360-635-8776
Mailing Address - Fax:360-397-8017
Practice Address - Street 1:908 5TH AVE SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1507
Practice Address - Country:US
Practice Address - Phone:360-754-2423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1699162925Medicaid