Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | A1108075 | AR |
NPI | 1003173774 |
---|---|
Provider Name | Zachary Haugh |
First Address | Judsonia, AR 72081-9302 |
Second Address | Judsonia, AR 72081-9302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2012 |
Last Update Date | 18/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A1108075 | LAC (01) | AR |