Provider Demographics
NPI:1821777160
Name:SHORT, HALEY L (LCMHC, NCC)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:L
Last Name:SHORT
Suffix:
Gender:F
Credentials:LCMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-1310
Mailing Address - Country:US
Mailing Address - Phone:828-434-5216
Mailing Address - Fax:
Practice Address - Street 1:181 NORTH ST
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-1310
Practice Address - Country:US
Practice Address - Phone:828-434-5216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0135324101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health