Provider Demographics
NPI:1508479700
Name:HADDAD, ROY (LPCC, LADC)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:
Last Name:HADDAD
Suffix:
Gender:M
Credentials:LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8120 PENN AVE S STE 500U
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-1367
Mailing Address - Country:US
Mailing Address - Phone:952-245-0369
Mailing Address - Fax:952-516-5282
Practice Address - Street 1:8120 PENN AVE S STE 500U
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-1367
Practice Address - Country:US
Practice Address - Phone:952-245-0369
Practice Address - Fax:952-516-5282
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN000000Medicaid