Healthcare Provider Details

I. General information

NPI: 1932100864
Provider Name (Legal Business Name): HAAG MENTAL HEALTH CONSULTING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N MAIN ST SUITE 3
POYNETTE WI
53955-8963
US

IV. Provider business mailing address

415 N MAIN ST SUITE 3
POYNETTE WI
53955-8963
US

V. Phone/Fax

Practice location:
  • Phone: 605-635-2146
  • Fax:
Mailing address:
  • Phone: 605-635-2146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2017-123
License Number StateWI

VIII. Authorized Official

Name: MS. VELMA HAAG
Title or Position: OWNER
Credential:
Phone: 608-635-2146