Provider Demographics
NPI:1164689527
Name:HAAKE, BRENT CHRISTOPHER
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:CHRISTOPHER
Last Name:HAAKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2686 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-3522
Mailing Address - Country:US
Mailing Address - Phone:650-365-5772
Mailing Address - Fax:
Practice Address - Street 1:2686 SPRING ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-3522
Practice Address - Country:US
Practice Address - Phone:650-365-5772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor