Provider Demographics
NPI:1811197288
Name:HAUGEN, INA LEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:INA
Middle Name:LEE
Last Name:HAUGEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 N CAMBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4525
Mailing Address - Country:US
Mailing Address - Phone:909-445-0447
Mailing Address - Fax:
Practice Address - Street 1:5TH STREET AND WESTERN AVENUE
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-0991
Practice Address - Country:US
Practice Address - Phone:951-737-2683
Practice Address - Fax:951-273-2974
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14997103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic