1790128379 NPI number — MISS CARLY J ROBINSON HAFTMANN LPC

Table of content: MISS CARLY J ROBINSON HAFTMANN LPC (NPI 1790128379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790128379 NPI number — MISS CARLY J ROBINSON HAFTMANN LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBINSON HAFTMANN
Provider First Name:
CARLY
Provider Middle Name:
J
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790128379
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3786 GRAY MARKET DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE CHARLES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70605-3111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-377-3626
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 INDUSTRIAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OBERLIN
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70655-3519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-639-3001
Provider Business Practice Location Address Fax Number:
337-639-3008
Provider Enumeration Date:
04/12/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LA 4166 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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