Provider Demographics
NPI:1154380533
Name:HAAS, LEONARD JARED (PHD)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:JARED
Last Name:HAAS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 CHIPETA WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1260
Mailing Address - Country:US
Mailing Address - Phone:801-587-3401
Mailing Address - Fax:801-581-2771
Practice Address - Street 1:375 CHIPETA WAY
Practice Address - Street 2:SUITE A
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1260
Practice Address - Country:US
Practice Address - Phone:801-587-3401
Practice Address - Fax:801-581-2771
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT00318-2501-4103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical