Mary Ann Havstad, M.A. LICSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

8300 Issued in MN

Practice address

9001 E Blgtn Frwy
Suite 140
Bloomington, MN 55420

Phone

(612) 518-5105

Fax

(952) 881-3588

NPI assigned

Dec 1, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1568530954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3703 TOWNDALE DR",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554311047",
            "telephone_number": "612-518-5105",
            "fax_number": "952-881-3588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9001 E BLGTN FRWY",
            "address_2": "SUITE 140",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "55420",
            "telephone_number": "612-518-5105",
            "fax_number": "952-881-3588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAVSTAD",
        "first_name": "MARY",
        "middle_name": "ANN",
        "credential": "M.A. LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "8300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittney Haukom
• Scott G Hauswirth, OD
• Gavin Santini Hautala, MD
• Danielle Marie Hautman, PA-C
• Haven Health LLC (iride)
• Abdiaziz A Hawadle
• Jordan Makenize Hawkins
• Kyla Raquel Hawkins
• Whitley Lynn Hawkins
• Elle Hawkinson, AUDIOLOGIST

• Mental Health Counselor in Bloomington, MN
• Providers in Bloomington, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.