Provider Demographics
NPI:1033201843
Name:HAERTNER, DAVID PAUL (LPC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PAUL
Last Name:HAERTNER
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:PO BOX 943
Mailing Address - Street 2:
Mailing Address - City:HONDO
Mailing Address - State:TX
Mailing Address - Zip Code:78861-0943
Mailing Address - Country:US
Mailing Address - Phone:830-426-1193
Mailing Address - Fax:830-426-4995
Practice Address - Street 1:1613 AVENUE K
Practice Address - Street 2:SUITE 109
Practice Address - City:HONDO
Practice Address - State:TX
Practice Address - Zip Code:78861-1800
Practice Address - Country:US
Practice Address - Phone:830-426-1193
Practice Address - Fax:830-426-4995
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14710101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0958951-01Medicaid
TX3792LCMedicare UPIN