Healthcare Provider Details

I. General information

NPI: 1235784810
Provider Name (Legal Business Name): AARON KIMBALL HASLAM PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2019
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 21ST ST SE
RIO RANCHO NM
87124-4030
US

IV. Provider business mailing address

PO BOX 45121
RIO RANCHO NM
87174-5121
US

V. Phone/Fax

Practice location:
  • Phone: 505-302-1492
  • Fax: 505-212-0001
Mailing address:
  • Phone: 505-302-1492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY1560
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1560
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: