Provider Demographics
NPI:1730204835
Name:HAIRE, JEREMY CLAYTON (MS, EDS)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:CLAYTON
Last Name:HAIRE
Suffix:
Gender:M
Credentials:MS, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4577 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WEST LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:47991-8089
Mailing Address - Country:US
Mailing Address - Phone:812-371-1537
Mailing Address - Fax:
Practice Address - Street 1:701 N ENGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-9744
Practice Address - Country:US
Practice Address - Phone:765-361-9767
Practice Address - Fax:765-361-0374
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001953A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health