Provider Demographics
NPI:1548724131
Name:ALLEN HASLAR, MIREYA
Entity type:Individual
Prefix:
First Name:MIREYA
Middle Name:
Last Name:ALLEN HASLAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 ELM ST NE
Mailing Address - Street 2:CROSSROADS FOR WOMEN
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102
Mailing Address - Country:US
Mailing Address - Phone:505-242-1010
Mailing Address - Fax:505-242-1551
Practice Address - Street 1:239 ELM ST NE
Practice Address - Street 2:CROSSROADS FOR WOMEN
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102
Practice Address - Country:US
Practice Address - Phone:505-242-1010
Practice Address - Fax:505-242-1551
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NM172V00000X
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No172V00000XOther Service ProvidersCommunity Health Worker