Provider Demographics
NPI:1790890812
Name:BASQUIN, KALLON (LCSW)
Entity Type:Individual
Prefix:
First Name:KALLON
Middle Name:
Last Name:BASQUIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 N. INDIAN HILL BLVD.
Mailing Address - Street 2:STE. 201
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711
Mailing Address - Country:US
Mailing Address - Phone:909-624-1122
Mailing Address - Fax:909-625-3210
Practice Address - Street 1:219 N INDIAN HILL BLVD
Practice Address - Street 2:STE. 201
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4644
Practice Address - Country:US
Practice Address - Phone:909-624-1122
Practice Address - Fax:909-625-3210
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS7308101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health