Provider Demographics
NPI:1275668436
Name:HALDEMAN, DOUGLAS C (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:C
Last Name:HALDEMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 WESTERN AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-2163
Mailing Address - Country:US
Mailing Address - Phone:206-443-4306
Mailing Address - Fax:206-728-1180
Practice Address - Street 1:2001 WESTERN AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-2163
Practice Address - Country:US
Practice Address - Phone:206-443-4306
Practice Address - Fax:206-728-1180
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY1072103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist