=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861723348
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLAREMONT COUNSELING AND SUPPORT CENTER A PSYCHOLOGICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2010
-----------------------------------------------------
Last Update Date | 01/22/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 W FIRST ST SUITE 230
-----------------------------------------------------
City | CLAREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91711-4736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-624-1997
-----------------------------------------------------
Fax | 909-624-4409
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 250 W FIRST ST SUITE 230
-----------------------------------------------------
City | CLAREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91711-4736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-624-1997
-----------------------------------------------------
Fax | 909-624-4409
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KARI I HALKO-WEEKES
-----------------------------------------------------
Credential | PSYCHOLOGIST, PH.D
-----------------------------------------------------
Telephone | 909-624-1997
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PSY22121
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------