Provider Demographics
NPI:1104709799
Name:CARSON, HALEY GRACE
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:GRACE
Last Name:CARSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W EMELINE ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:IN
Mailing Address - Zip Code:46542-9432
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:611 W EMELINE ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:IN
Practice Address - Zip Code:46542-9432
Practice Address - Country:US
Practice Address - Phone:574-658-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-25-446143106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician