MEDICARE: KAREN Y HAAS AMFT132807

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	AMFT132807	CA

General Provider Information

NPI Number	:	1205535473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN Y HAAS AMFT132807

Provider Business Mailing Address
First Line	:	50 SEQUOIA CIR
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-4990
Country	:	US
Telephone Number	:	707-494-2205
Fax Number	:

Provider Business Practice Location Address
First Line	:	838 4TH ST STE A
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-4538
Country	:	US
Telephone Number	:	707-494-2205
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2023
Last Update Date	:	02/27/2023

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