Provider Demographics
NPI:1588441992
Name:TAMARA J HAASE PLLC
Entity type:Organization
Organization Name:TAMARA J HAASE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAASE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:231-740-1561
Mailing Address - Street 1:781 S MAPLE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-9480
Mailing Address - Country:US
Mailing Address - Phone:231-740-1561
Mailing Address - Fax:
Practice Address - Street 1:781 S MAPLE ISLAND RD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-9480
Practice Address - Country:US
Practice Address - Phone:231-740-1561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty