1639596703 NPI number — MRS. FRANCHESCA JOUBERT HASELRIG LMFT

Table of content: MRS. FRANCHESCA JOUBERT HASELRIG LMFT (NPI 1639596703)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639596703 NPI number — MRS. FRANCHESCA JOUBERT HASELRIG LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HASELRIG
Provider First Name:
FRANCHESCA
Provider Middle Name:
JOUBERT
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HASELRIG
Provider Other First Name:
FRANCHESCA
Provider Other Middle Name:
JOUBERT
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639596703
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
473 E CARNEGIE DRIVE
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
SAN BERNARDINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92408-4201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-208-2797
Provider Business Mailing Address Fax Number:
855-964-1168

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
473 E CARNEGIE DRIVE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
SAN BERNARDINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92408-4201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-208-2797
Provider Business Practice Location Address Fax Number:
855-964-1168
Provider Enumeration Date:
03/26/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  113493 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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