Provider Demographics
NPI:1154542215
Name:DEHAAN, CHRISTINE B (PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:B
Last Name:DEHAAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13110 SEAVIEW LN
Mailing Address - Street 2:APT 245E
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-3468
Mailing Address - Country:US
Mailing Address - Phone:818-345-0826
Mailing Address - Fax:
Practice Address - Street 1:21241 VENTURA BLVD.
Practice Address - Street 2:267
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364
Practice Address - Country:US
Practice Address - Phone:818-881-9776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15638103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical