Provider Demographics
NPI:1154834620
Name:HAAKE, AMY (LPCC-SUPV)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HAAKE
Suffix:
Gender:F
Credentials:LPCC-SUPV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9378 S MASON MONTGOMERY RD # 450
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-8827
Mailing Address - Country:US
Mailing Address - Phone:513-849-8162
Mailing Address - Fax:
Practice Address - Street 1:9378 S MASON MONTGOMERY RD # 450
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-8827
Practice Address - Country:US
Practice Address - Phone:513-849-8162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1901528-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0074946OtherODMH
OH0074861OtherODADAS
OH01-0963OtherCARF
OHH130910OtherPTAN GROUP