Healthcare Provider Details

I. General information

NPI: 1629785407
Provider Name (Legal Business Name): DONNELLE ADRIAN HAUN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ADRIAN HAUN LPC

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 N NEBULA AVE
STAR ID
83669-5474
US

IV. Provider business mailing address

628 N NEBULA AVE
STAR ID
83669-5474
US

V. Phone/Fax

Practice location:
  • Phone: 208-903-2640
  • Fax:
Mailing address:
  • Phone: 805-270-0390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8371348
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: