Provider Demographics
NPI:1275120206
Name:HAID, SAMUEL BEN ANDREW
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:BEN ANDREW
Last Name:HAID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 VINE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-2922
Mailing Address - Country:US
Mailing Address - Phone:404-909-4080
Mailing Address - Fax:
Practice Address - Street 1:1100 VINE ST APT 3
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-2922
Practice Address - Country:US
Practice Address - Phone:404-909-4080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-23
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2022-0960101YM0800X
22-192221700000X
COLPC.0020635101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist