Healthcare Provider Details

I. General information

NPI: 1982352407
Provider Name (Legal Business Name): HALO CONSULTING GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1426 PALOMA ST
LOS ANGELES CA
90021-2620
US

IV. Provider business mailing address

3425 W MANCHESTER BLVD
INGLEWOOD CA
90305-2101
US

V. Phone/Fax

Practice location:
  • Phone: 323-917-8843
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MIRNA BELTRAN
Title or Position: CLINICAL DIRECTOR
Credential: LCSW
Phone: 323-917-8843