Provider Information for 1598055501
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MARK HAASE LPC
Sex: Male
NPI: 1598055501
Last Updated: 2011-04-11
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1598055501 | ||||||||
| Enumeration Date | 2011-04-11 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 513 SOPHIA ST RIVER RIDGE, LA 70123-1137 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 513 SOPHIA ST RIVER RIDGE, LA 70123-1137 United States Phone: 504-738-9126 | Fax: | ||||||||
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