Provider Demographics
NPI:1942369434
Name:HAAS, DONNA MAE (MED MENTAL HEALTH CO)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:MAE
Last Name:HAAS
Suffix:
Gender:F
Credentials:MED MENTAL HEALTH CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 WONDERLAND PASS
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076
Mailing Address - Country:US
Mailing Address - Phone:615-885-9849
Mailing Address - Fax:615-885-9088
Practice Address - Street 1:105 BONNABROOK DR
Practice Address - Street 2:STE 203
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1426
Practice Address - Country:US
Practice Address - Phone:615-391-3735
Practice Address - Fax:615-885-9088
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0892101YA0400X
TN1550101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7717392OtherAETNA
TN261426OtherCOMPSYCH
TN4103750OtherBCBS
TN490308OtherVALUE OPTIONS