Provider Demographics
NPI:1346734514
Name:STEEN, HAYNE ADDISON
Entity Type:Individual
Prefix:
First Name:HAYNE
Middle Name:ADDISON
Last Name:STEEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-0313
Mailing Address - Country:US
Mailing Address - Phone:904-559-1944
Mailing Address - Fax:
Practice Address - Street 1:38 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-0313
Practice Address - Country:US
Practice Address - Phone:904-559-1944
Practice Address - Fax:904-559-1998
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16012101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health