Healthcare Provider Details

I. General information

NPI: 1821239633
Provider Name (Legal Business Name): HALEY KEMPFF FUSELIER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 06/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 HAMPTON DR
VENICE CA
90291-2623
US

IV. Provider business mailing address

204 HAMPTON DR
VENICE CA
90291-2623
US

V. Phone/Fax

Practice location:
  • Phone: 310-399-6878
  • Fax: 310-399-1339
Mailing address:
  • Phone: 310-399-6878
  • Fax: 310-399-1339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: