Provider Demographics
NPI:1205535473
Name:HAAS, KAREN Y (AMFT132807)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:Y
Last Name:HAAS
Suffix:
Gender:F
Credentials:AMFT132807
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 SEQUOIA CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4990
Mailing Address - Country:US
Mailing Address - Phone:707-494-2205
Mailing Address - Fax:
Practice Address - Street 1:838 4TH ST STE A
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4538
Practice Address - Country:US
Practice Address - Phone:707-494-2205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT132807106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist