Provider Demographics
NPI:1568734010
Name:HAASE, PAMELA JEAN (MS, LLPC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:HAASE
Suffix:
Gender:F
Credentials:MS, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 N MILL ST
Mailing Address - Street 2:THE UPPER ROOM
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1422
Mailing Address - Country:US
Mailing Address - Phone:734-748-5988
Mailing Address - Fax:734-468-0217
Practice Address - Street 1:632 N MILL ST
Practice Address - Street 2:THE UPPER ROOM
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1422
Practice Address - Country:US
Practice Address - Phone:734-748-5988
Practice Address - Fax:734-468-0217
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012171101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional