MEDICARE: JOANNA LEE HAASE PH.D., MFT

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	101YM0800X	Mental Health Counselor	22234	CA

General Provider Information

NPI Number	:	1255624417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA LEE HAASE PH.D., MFT

Provider Business Mailing Address
First Line	:	572 E GREEN ST STE 208
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-2070
Country	:	US
Telephone Number	:	626-799-7907
Fax Number	:

Provider Business Practice Location Address
First Line	:	572 E GREEN ST STE 208
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-2070
Country	:	US
Telephone Number	:	626-799-7907
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2011
Last Update Date	:	05/20/2011

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