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General NPI Number Information
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NPI Number | 1306040118
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Entity Type | Individual
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Provider Name | JOHN MARK HANEY PHD, LPC
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Gender | Male
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Dates
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Enumeration Date | 06/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4131 SPICEWOOD SPRINGS RD STE O3
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City | AUSTIN
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State | TX
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Zip | 78759-8664
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Country | US
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Telephone | 512-346-9299
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Fax | 512-264-3729
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Provider Business Mailing Address
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Address Line | 1912 SHADOWBROOK CIR
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City | ROUND ROCK
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State | TX
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Zip | 78681-7139
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Country | US
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Telephone | 512-388-4172
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Fax | 512-264-3729
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 19095
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License Number State | TX
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