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General NPI Number Information
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NPI Number | 1447427273
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Entity Type | Individual
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Provider Name | MARYANN L HASELDEN LMHC, CAP
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Gender | Female
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Dates
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Enumeration Date | 05/12/2008
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Last Update Date | 05/12/2008
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Provider Practice Location Address
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Address Line | 3112 17TH ST
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City | SAINT CLOUD
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State | FL
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Zip | 34769-6021
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Country | US
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Telephone | 407-957-4176
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Fax | 407-957-4359
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Provider Business Mailing Address
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Address Line | 1707 SAINT TROPEZ CT
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City | KISSIMMEE
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State | FL
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Zip | 34744-3957
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Country | US
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Telephone | 407-709-8571
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Fax | 407-847-0607
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 3411
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License Number State | FL
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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 | 8745
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License Number State | FL
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