Provider Demographics
NPI:1881704310
Name:HASLER, CONNIE (MA, LMFT)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:HASLER
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 S ALMA SCHOOL RD
Mailing Address - Street 2:C-107
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3064
Mailing Address - Country:US
Mailing Address - Phone:480-929-6192
Mailing Address - Fax:
Practice Address - Street 1:1930 S ALMA SCHOOL RD
Practice Address - Street 2:C-107
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3064
Practice Address - Country:US
Practice Address - Phone:480-929-6192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-0277106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist