Provider Demographics
NPI:1861723348
Name:CLAREMONT COUNSELING AND SUPPORT CENTER A PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:CLAREMONT COUNSELING AND SUPPORT CENTER A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARI
Authorized Official - Middle Name:I
Authorized Official - Last Name:HALKO-WEEKES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYCHOLOGIST, PHD
Authorized Official - Phone:909-624-1997
Mailing Address - Street 1:250 W FIRST ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4736
Mailing Address - Country:US
Mailing Address - Phone:909-624-1997
Mailing Address - Fax:909-624-4409
Practice Address - Street 1:250 W FIRST ST
Practice Address - Street 2:SUITE 230
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4736
Practice Address - Country:US
Practice Address - Phone:909-624-1997
Practice Address - Fax:909-624-4409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22121103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty