Healthcare Provider Details

I. General information

NPI: 1811176191
Provider Name (Legal Business Name): SUZAN KAY HAAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S MAIN ST SUITE 249
LAS CRUCES NM
88001-1206
US

IV. Provider business mailing address

505 S MAIN ST SUITE 249
LAS CRUCES NM
88001-1206
US

V. Phone/Fax

Practice location:
  • Phone: 505-527-5823
  • Fax: 505-527-5886
Mailing address:
  • Phone: 505-527-5823
  • Fax: 505-527-5886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0106771
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: