Provider Demographics
NPI:1174251342
Name:ELMENDORF, HAYDEN R (LCMHC)
Entity type:Individual
Prefix:
First Name:HAYDEN
Middle Name:R
Last Name:ELMENDORF
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05601-0647
Mailing Address - Country:US
Mailing Address - Phone:802-828-3983
Mailing Address - Fax:802-223-0842
Practice Address - Street 1:34 BARRE ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3510
Practice Address - Country:US
Practice Address - Phone:802-828-3983
Practice Address - Fax:802-223-0842
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0134761101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health