Provider Demographics
NPI:1952853418
Name:HALIM, SUSAN (MA, MS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:HALIM
Suffix:
Gender:F
Credentials:MA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4438
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92616-4438
Mailing Address - Country:US
Mailing Address - Phone:949-529-7947
Mailing Address - Fax:
Practice Address - Street 1:1001 DOVE ST
Practice Address - Street 2:SUITE 280
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2838
Practice Address - Country:US
Practice Address - Phone:949-923-8961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF75966106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist