Provider Demographics
NPI:1164608030
Name:HAUG, DIANE K (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:K
Last Name:HAUG
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 CAMINO LA CUEVA
Mailing Address - Street 2:
Mailing Address - City:GLORIETA
Mailing Address - State:NM
Mailing Address - Zip Code:87535-7012
Mailing Address - Country:US
Mailing Address - Phone:505-757-2939
Mailing Address - Fax:
Practice Address - Street 1:39 CAMINO LA CUEVA
Practice Address - Street 2:
Practice Address - City:GLORIETA
Practice Address - State:NM
Practice Address - Zip Code:87535-7012
Practice Address - Country:US
Practice Address - Phone:505-757-2939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1217101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health