Healthcare Provider Details

I. General information

NPI: 1952228520
Provider Name (Legal Business Name): GRIFFEN HALKO LAADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W 1ST ST STE 250
CLAREMONT CA
91711-4745
US

IV. Provider business mailing address

250 W 1ST ST STE 250
CLAREMONT CA
91711-4745
US

V. Phone/Fax

Practice location:
  • Phone: 909-624-1997
  • Fax:
Mailing address:
  • Phone: 909-624-1997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLR02871218
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: