Doctor Name: | MARK HAASE |
NPI Number: | 1598055501 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | 3197 |
Business Practice Address: | 513 Sophia St River Ridge, LA - 701231137 |
Business Phone Number: | 5047389126 |
Business Fax Number: | |
Mailing Address: | 513 Sophia St, RIVER RIDGE |
State: | LA |
Postal Code: | 701231137 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 04/11/2011 |
NPI Last Update Date: | 04/11/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 3197 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |