Healthcare Provider Details

I. General information

NPI: 1134692908
Provider Name (Legal Business Name): STEPHANIE L HAASIS LPC, MAC, CDCII
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 HOSPITAL PL
SOLDOTNA AK
99669-7559
US

IV. Provider business mailing address

245 N BINKLEY ST STE 202
SOLDOTNA AK
99669-7500
US

V. Phone/Fax

Practice location:
  • Phone: 907-714-4521
  • Fax:
Mailing address:
  • Phone: 319-290-7911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4245
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number132160
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: