MEDICARE: HAAS PSYCHIATRIC SERVICES, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	E-0446	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124482971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAAS PSYCHIATRIC SERVICES, PA

Provider Business Mailing Address
First Line	:	2001 CLUB MANOR DR STE J
Second Line	:
City	:	MAUMELLE
State	:	AR
Zip	:	72113-7417
Country	:	US
Telephone Number	:	501-687-0488
Fax Number	:	501-687-0489

Provider Business Practice Location Address
First Line	:	2001 CLUB MANOR DR STE J
Second Line	:
City	:	MAUMELLE
State	:	AR
Zip	:	72113-7417
Country	:	US
Telephone Number	:	501-687-0488
Fax Number	:	501-687-0489

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID CHARLES HAAS
Credential	:	M.D.
Telephone Number	:	501-687-0488

Provider Enumeration Date	:	04/07/2016
Last Update Date	:	04/07/2016

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