ERICH STEPHEN HAEZEBROUCK PSYD
NPI 1194006296
Psychologist in Wheat Ridge, CO

Active since September 01, 2011Opted out of Medicare · through Apr 19, 2028
4851 INDEPENDENCE ST, SUITE 200, WHEAT RIDGE, CO 80033(303) 425-0300(303) 432-5071 Get Directions Write a Review

NPPES record last updated: January 20, 2022. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Erich Stephen Haezebrouck Psyd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ERICH STEPHEN HAEZEBROUCK PSYD (NPI 1194006296) is an individual psychologist in Wheat Ridge, Colorado, licensed in California (32789) and active in the NPI registry since September 2011. He has opted out of Medicare through April 19, 2028.

NPPES Registry Identity

NPI1194006296
Entity TypeIndividualMale
Primary Taxonomy103T00000X
Provider Legal NameERICH STEPHEN HAEZEBROUCKCredential: PSYD
Location Address4851 INDEPENDENCE ST, SUITE 200Wheat Ridge, CO 80033-6715
Mailing Address41856 Ivy St Ste 205Murrieta, CA 92562-8805 · (951) 468-0265
Fax(303) 432-5071
Sole ProprietorYes
Enumeration DateSeptember 1, 2011
Last NPPES UpdateJanuary 20, 2022
NPPES CertifiedJanuary 20, 2022
NPI 1194006296 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License Licensed in CA · 32789
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X
4851 INDEPENDENCE ST, Wheat Ridge, CO 80033

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Opted out of Medicare

Erich Stephen Haezebrouck Psyd has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from April 19, 2022 through April 19, 2028.

Opt-Out Effective DateApril 19, 2022
Opt-Out In Effect ThroughApril 19, 2028Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Peer Specialist
4851 INDEPENDENCE ST
WHEAT RIDGE, CO 80033
Social Worker (Clinical)
4851 INDEPENDENCE ST
WHEAT RIDGE, CO 80033
Clinic/Center (Mental Health (Including Community Mental Health Center))
4851 INDEPENDENCE ST
WHEAT RIDGE, CO 80033
Behavior Analyst
4851 INDEPENDENCE ST
WHEAT RIDGE, CO 80033
Registered Nurse (Psychiatric/Mental Health)
4851 INDEPENDENCE ST, SUITE 200
WHEAT RIDGE, CO 80033
Psychologist (Clinical)
4851 INDEPENDENCE ST, SUITE 200
WHEAT RIDGE, CO 80033
Social Worker (Clinical)
4851 INDEPENDENCE ST
WHEAT RIDGE, CO 80033
Counselor (Professional)
4851 INDEPENDENCE ST, SUITE 200
WHEAT RIDGE, CO 80033

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Erich Haezebrouck's NPI number?

The NPI number for Erich Haezebrouck is 1194006296. It was assigned to this individual provider in the NPPES registry on September 1, 2011.

Where is Erich Haezebrouck located?

Erich Haezebrouck practices at 4851 Independence St Suite 200, Wheat Ridge, CO 80033. The listed phone number is (303) 425-0300.

What is Erich Haezebrouck's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Erich Haezebrouck enrolled in Medicare?

No. Erich Haezebrouck has opted out of Medicare through April 19, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Erich Haezebrouck was last updated on January 20, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.