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General NPI Number Information
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NPI Number | 1184055568
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Entity Type | Organization
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Legal Business Name | MARY P HASKINS LLC
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Dates
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Enumeration Date | 12/10/2013
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Last Update Date | 12/10/2013
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Provider Practice Location Address
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Address Line | 1627 E MILITARY AVE SUITE 200
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City | FREMONT
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State | NE
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Zip | 68025-5490
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Country | US
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Telephone | 402-727-4886
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Fax | 402-727-4146
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Provider Business Mailing Address
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Address Line | 1627 E MILITARY AVE SUITE 200
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City | FREMONT
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State | NE
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Zip | 68025-5490
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Country | US
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Telephone | 402-727-4886
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Fax | 402-727-4146
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Authorized Official
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Title or Position | OWNER
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Name | MARY P HASKINS
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Credential | LCSW, LMHP, LADC
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Telephone | 402-727-4886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 855
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3724
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1369
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License Number State | NE
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