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General NPI Number Information
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NPI Number | 1104000769
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Entity Type | Individual
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Provider Name | STACY HAAG LPC/MHSP
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Gender | Female
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 05/06/2024
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Provider Practice Location Address
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Address Line | 105 OTIS SMITH DR
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City | CLARKSVILLE
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State | TN
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Zip | 37043-8940
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Country | US
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Telephone | 931-320-9213
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Fax |
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Provider Business Mailing Address
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Address Line | 105 OTIS SMITH DR
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City | CLARKSVILLE
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State | TN
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Zip | 37043-8940
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Country | US
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Telephone | 931-320-9213
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1407
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3299
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License Number State | TN
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