Healthcare Provider Details

I. General information

NPI: 1649586686
Provider Name (Legal Business Name): KRISTIN LAUREL HAASE M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 4TH ST 2ND FLOOR
SANTA MONICA CA
90401-2358
US

IV. Provider business mailing address

1527 4TH ST 2ND FLOOR
SANTA MONICA CA
90401-2358
US

V. Phone/Fax

Practice location:
  • Phone: 310-394-9871
  • Fax:
Mailing address:
  • Phone: 310-394-9871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: