Provider Demographics
NPI:1427737337
Name:HAAS, DYLAN (LPC)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:HAAS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3613 N CAMBORNE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-4516
Mailing Address - Country:US
Mailing Address - Phone:208-861-3134
Mailing Address - Fax:
Practice Address - Street 1:410 S ORCHARD ST STE 220
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1275
Practice Address - Country:US
Practice Address - Phone:208-994-4137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-9602101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health