Provider Demographics
NPI:1518390723
Name:ROSE HAAS, SHERI LYN (MA, LPP)
Entity Type:Individual
Prefix:MS
First Name:SHERI
Middle Name:LYN
Last Name:ROSE HAAS
Suffix:
Gender:F
Credentials:MA, LPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1136
Mailing Address - Street 2:592 KY 15 SOUTH, SUITE 5
Mailing Address - City:CAMPTON
Mailing Address - State:KY
Mailing Address - Zip Code:41301-1136
Mailing Address - Country:US
Mailing Address - Phone:606-205-3133
Mailing Address - Fax:866-718-4137
Practice Address - Street 1:1767 CAMPTON-BAPTIST ROAD
Practice Address - Street 2:
Practice Address - City:CAMPTON
Practice Address - State:KY
Practice Address - Zip Code:41301-1136
Practice Address - Country:US
Practice Address - Phone:606-205-3133
Practice Address - Fax:866-718-4137
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPSYPPR00216468103TC0700X
KYKY-0554171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No171W00000XOther Service ProvidersContractor