Provider Demographics
NPI:1578870648
Name:DE HAAN, MATTHEW RALPH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:RALPH
Last Name:DE HAAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 216TH ST SW
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-7528
Mailing Address - Country:US
Mailing Address - Phone:619-307-1420
Mailing Address - Fax:
Practice Address - Street 1:16000 BOTHELL EVERETT HWY
Practice Address - Street 2:SUITE 340
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1742
Practice Address - Country:US
Practice Address - Phone:425-780-7184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60337257103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical