Provider Demographics
NPI:1154004620
Name:HAAS, AMANDA (PHD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:HAAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 S ALMA SCHOOL RD STE C108
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3067
Mailing Address - Country:US
Mailing Address - Phone:480-952-5993
Mailing Address - Fax:
Practice Address - Street 1:1930 S ALMA SCHOOL RD STE A210
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3046
Practice Address - Country:US
Practice Address - Phone:480-331-9134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005755103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical