Provider Demographics
NPI:1306040118
Name:HANEY, JOHN MARK (PHD, LPC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MARK
Last Name:HANEY
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 SHADOWBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-7139
Mailing Address - Country:US
Mailing Address - Phone:512-388-4172
Mailing Address - Fax:512-264-3729
Practice Address - Street 1:4131 SPICEWOOD SPRINGS RD STE O3
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8664
Practice Address - Country:US
Practice Address - Phone:512-346-9299
Practice Address - Fax:512-264-3729
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19095101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicaid