Provider Demographics
NPI:1700042082
Name:HAAN, THOMAS LEE
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LEE
Last Name:HAAN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:THOMAS
Other - Middle Name:LEE
Other - Last Name:HAAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PC
Mailing Address - Street 1:1621 FREEWAY DR STE 101C
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-2462
Mailing Address - Country:US
Mailing Address - Phone:360-920-5747
Mailing Address - Fax:
Practice Address - Street 1:1621 FREEWAY DR STE 101C
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2462
Practice Address - Country:US
Practice Address - Phone:360-920-5747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00045873101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional