Healthcare Provider Details

I. General information

NPI: 1235483975
Provider Name (Legal Business Name): HALLIE JOCELYN BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14505 KRAMER RANCH RD
CHINO HILLS CA
91709-5454
US

IV. Provider business mailing address

1907 BOYS REPUBLIC DR
CHINO HILLS CA
91709-5447
US

V. Phone/Fax

Practice location:
  • Phone: 909-740-3137
  • Fax: 909-306-5427
Mailing address:
  • Phone: 909-628-1217
  • Fax: 909-306-5427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number102749
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number141801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: