Healthcare Provider Details

I. General information

NPI: 1326547092
Provider Name (Legal Business Name): JOHN MARTIN HAASE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2018
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 N SPRIGG ST # 5526
CAPE GIRARDEAU MO
63701-5526
US

IV. Provider business mailing address

425 BROADWAY ST
PADUCAH KY
42001-0713
US

V. Phone/Fax

Practice location:
  • Phone: 573-332-7992
  • Fax: 573-332-7998
Mailing address:
  • Phone: 270-442-7121
  • Fax: 270-442-5729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2024047770
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number271542
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: