MEDICARE: MR. MOTIER HASKINS MS, MHC-LP

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1750854683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MOTIER HASKINS MS, MHC-LP

Provider Business Mailing Address
First Line	:	1 HUTTON ST
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12204-1717
Country	:	US
Telephone Number	:	518-248-5049
Fax Number	:

Provider Business Practice Location Address
First Line	:	395 ELK ST
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12206-2707
Country	:	US
Telephone Number	:	518-248-5049
Fax Number	:

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

Provider Enumeration Date	:	01/03/2019
Last Update Date	:	03/25/2020

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