Basic Information
| Provider Information | |||||||||
| NPI: | 1275073439 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HASKINS | ||||||||
| FirstName: | MERRIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MS, LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2624 PROMONTORY PL E | ||||||||
| Address2: | |||||||||
| City: | MAPLEWOOD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551195841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6127042423 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1919 UNIVERSITY AVE W STE 200 | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551043435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512667845 | ||||||||
| FaxNumber: | 6512667850 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2017 | ||||||||
| LastUpdateDate: | 07/03/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 01468 | MN | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 1468 | MN | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.