Active NPI
Mark L Haugen, PH.D., L.P.
- Clinical Psychologist
- Bemidji, MN
National Provider Identifier
1528065000
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP1398
- Practice address
- 1526 30TH St NW
Bemidji, MN 56601-4133 - Phone
- (218) 751-0887
- NPI assigned
- Jun 30, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP1398 | MN | Primary |
Addresses
Primary practice location
1526 30TH St NW
Bemidji, MN 56601-4133
Mailing address
1526 30TH St NW
Bemidji, MN 56601-4133
Phone (218) 751-0887
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 143550700 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1398 | MN | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559088000000",
"number": "1528065000",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1526 30TH ST NW",
"city": "BEMIDJI",
"state": "MN",
"postal_code": "566014133",
"telephone_number": "218-751-0887"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1526 30TH ST NW",
"city": "BEMIDJI",
"state": "MN",
"postal_code": "566014133",
"telephone_number": "218-751-0887"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAUGEN",
"first_name": "MARK",
"middle_name": "L",
"credential": "PH.D., L.P.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-06-30",
"last_updated": "2019-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP1398",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "143550700",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bemidji, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.