Provider Demographics
NPI:1235784810
Name:HASLAM, AARON KIMBALL (PHD)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:KIMBALL
Last Name:HASLAM
Suffix:
Gender:M
Credentials:PHD
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 45121
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87174-5121
Mailing Address - Country:US
Mailing Address - Phone:505-302-1492
Mailing Address - Fax:
Practice Address - Street 1:3309 ZIA ST NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-5335
Practice Address - Country:US
Practice Address - Phone:505-302-1492
Practice Address - Fax:505-212-0001
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPSY1560103TC0700X
NM1560103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical