Provider Demographics
NPI:1336472117
Name:HAESLOOP, BRIAN ARTHUR
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ARTHUR
Last Name:HAESLOOP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 LOS FELIZ WAY
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-5344
Mailing Address - Country:US
Mailing Address - Phone:916-402-9185
Mailing Address - Fax:
Practice Address - Street 1:3990 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3430
Practice Address - Country:US
Practice Address - Phone:916-796-0020
Practice Address - Fax:916-796-0045
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CAA06960315101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)