Provider Demographics
NPI:1467473645
Name:HAASE, ERRYN ALICE (MFT)
Entity Type:Individual
Prefix:
First Name:ERRYN
Middle Name:ALICE
Last Name:HAASE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:ERRYN
Other - Middle Name:
Other - Last Name:TAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:5543 RIDGEPOINT DR
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-3737
Mailing Address - Country:US
Mailing Address - Phone:925-917-9607
Mailing Address - Fax:
Practice Address - Street 1:3175 SUNSET BLVD STE 104
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-3091
Practice Address - Country:US
Practice Address - Phone:925-917-9607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48305106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist