Kelly Anne Haider, MS, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

C6923 Issued in OR

Practice address

223 Commercial St NE Ste 206
Salem, OR 97301-4078

Phone

(035) 580-0291

Fax

(035) 583-2952

NPI assigned

Sep 8, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• Kelly Anne Smith Former name

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Haider Therapy LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Salem, OR
  • NPI 1316879604
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703635200000",
    "number": "1528515434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6677 14TH AVE NE",
            "city": "KEIZER",
            "state": "OR",
            "postal_code": "973031871",
            "telephone_number": "035-580-0291",
            "fax_number": "503-749-6051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "223 COMMERCIAL ST NE STE 206",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973014078",
            "telephone_number": "035-580-0291",
            "fax_number": "035-583-2952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAIDER",
        "first_name": "KELLY",
        "middle_name": "ANNE",
        "name_prefix": "Ms.",
        "credential": "MS, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-08",
        "last_updated": "2023-12-27",
        "certification_date": "2023-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "R-6443",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "C6923",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "122944",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500713541",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON BOARD OF LICENSED PROFESSIONAL COUNSELORS AND THERAPISTS",
            "identifier": "C6923",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "SMITH",
            "middle_name": "ANNE",
            "credential": "QMHP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Daniel Hahn
• Holly Laura Hahn, RDH
• Michael Patrick Hahn, MD
• Shannon Rae Hahn, EPDH
• Haider Therapy LLC
• R. Jeremy Haider, DMD
• Victoria Haight
• Kedward Haines
• Faith Haining
• May Christina Halabi

• Mental Health Counselor in Salem, OR
• Providers in Salem, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.