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General NPI Number Information
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NPI Number | 1790890812
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Entity Type | Individual
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Provider Name | KALLON BASQUIN L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 219 N INDIAN HILL BLVD STE. 201
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City | CLAREMONT
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State | CA
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Zip | 91711-4644
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Country | US
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Telephone | 909-624-1122
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Fax | 909-625-3210
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Provider Business Mailing Address
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Address Line | 219 N. INDIAN HILL BLVD. STE. 201
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City | CLAREMONT
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State | CA
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Zip | 91711
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Country | US
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Telephone | 909-624-1122
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Fax | 909-625-3210
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCS7308
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License Number State | CA
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