Healthcare Provider Details

I. General information

NPI: 1497586606
Provider Name (Legal Business Name): MEGAN HAYNIE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 GOLF COURSE RD SE
RIO RANCHO NM
87124-1999
US

IV. Provider business mailing address

1518 SIERRA NORTE LOOP NE
RIO RANCHO NM
87144-2520
US

V. Phone/Fax

Practice location:
  • Phone: 505-994-4100
  • Fax:
Mailing address:
  • Phone: 801-592-2664
  • 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: