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General NPI Number Information
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NPI Number | 1699530592
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Entity Type | Individual
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Provider Name | HEATHER JANTZ-HAUN LAC
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Gender | Female
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Dates
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Enumeration Date | 02/19/2024
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 3 THIRD ST STE 20
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City | BORDENTOWN
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State | NJ
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Zip | 08505-1370
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Country | US
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Telephone | 609-200-5598
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Fax |
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Provider Business Mailing Address
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Address Line | 215 E 2ND ST
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City | FLORENCE
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State | NJ
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Zip | 08518-1403
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Country | US
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Telephone | 609-462-4435
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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 | 37AC00390300
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License Number State | NJ
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