Provider Demographics
NPI:1124665963
Name:HAUN, ANGEL (MAADC)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:HAUN
Suffix:
Gender:F
Credentials:MAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-1931
Mailing Address - Country:US
Mailing Address - Phone:417-619-1595
Mailing Address - Fax:
Practice Address - Street 1:302 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-1931
Practice Address - Country:US
Practice Address - Phone:417-619-1595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO12172101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)