Provider Demographics
NPI:1235483975
Name:BROWN, HALLIE JOCELYN
Entity Type:Individual
Prefix:
First Name:HALLIE
Middle Name:JOCELYN
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 BOYS REPUBLIC DR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-5447
Mailing Address - Country:US
Mailing Address - Phone:909-628-1217
Mailing Address - Fax:909-306-5427
Practice Address - Street 1:14505 KRAMER RANCH RD
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-5454
Practice Address - Country:US
Practice Address - Phone:909-740-3137
Practice Address - Fax:909-306-5427
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102749106H00000X
CA141801106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7667OtherMEDI-CAL
CA7368OtherMEDI-CAL
CA7708OtherMEDI-CAL
CA7184OtherMEDI-CAL