Provider Demographics
NPI:1417179375
Name:HASLUND, ANN LEE (MFT)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:LEE
Last Name:HASLUND
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 ALHAMBRA DR.
Mailing Address - Street 2:3208
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-8866
Mailing Address - Country:US
Mailing Address - Phone:530-677-8985
Mailing Address - Fax:530-677-8985
Practice Address - Street 1:3075 ALHAMBRA DR.
Practice Address - Street 2:3208
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8866
Practice Address - Country:US
Practice Address - Phone:530-677-8985
Practice Address - Fax:530-677-8985
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC23466106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist