Provider Demographics
NPI:1679103188
Name:HASWOOD, LMHC, MICHELLE (LMHC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HASWOOD, LMHC
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1472
Mailing Address - Street 2:
Mailing Address - City:CROWNPOINT
Mailing Address - State:NM
Mailing Address - Zip Code:87313-1472
Mailing Address - Country:US
Mailing Address - Phone:505-290-3206
Mailing Address - Fax:
Practice Address - Street 1:1040 SAKELARES BLVD
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020-3819
Practice Address - Country:US
Practice Address - Phone:505-290-3206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program