Provider Demographics
NPI:1346295383
Name:HAST, JOHN TIMOTHY (MED LPC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:TIMOTHY
Last Name:HAST
Suffix:
Gender:M
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3631 N BRYANT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-4035
Mailing Address - Country:US
Mailing Address - Phone:405-844-8255
Mailing Address - Fax:405-348-3300
Practice Address - Street 1:171 STONEBRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-7375
Practice Address - Country:US
Practice Address - Phone:405-844-8255
Practice Address - Fax:405-348-3300
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2332101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional