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NPI Code Detail

MEDICARE: PAMELA JEAN HAASE M.S., L.L.P.C.

MEDICARE: PAMELA JEAN HAASE M.S., L.L.P.C.
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
1101YP2500XProfessional Counselor6401012171MI

General Provider Information

NPI Number : 1568734010
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAMELA JEAN HAASE M.S., L.L.P.C.
Provider Business Mailing Address
First Line : 632 N MILL ST
Second Line : THE UPPER ROOM
City : PLYMOUTH
State : MI
Zip : 48170-1422
Country : US
Telephone Number : 734-748-5988
Fax Number : 734-468-0217
Provider Business Practice Location Address
First Line : 632 N MILL ST
Second Line : THE UPPER ROOM
City : PLYMOUTH
State : MI
Zip : 48170-1422
Country : US
Telephone Number : 734-748-5988
Fax Number : 734-468-0217
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2012
Last Update Date : 01/30/2012

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