Provider Demographics
NPI:1942404942
Name:HAFER, GEORGE (MA)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:HAFER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-3373
Mailing Address - Country:US
Mailing Address - Phone:719-269-3229
Mailing Address - Fax:719-269-8328
Practice Address - Street 1:303 N 7TH ST
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-3373
Practice Address - Country:US
Practice Address - Phone:719-269-3229
Practice Address - Fax:719-269-8328
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5417101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional