Provider Demographics
NPI:1316240930
Name:HALCON, THERESA ANN
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ANN
Last Name:HALCON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24384 SUNNYMEAD BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-7765
Mailing Address - Country:US
Mailing Address - Phone:951-243-0303
Mailing Address - Fax:951-243-3006
Practice Address - Street 1:24384 SUNNYMEAD BLVD STE 240
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-7765
Practice Address - Country:US
Practice Address - Phone:951-243-0303
Practice Address - Fax:951-243-3006
Is Sole Proprietor?:No
Enumeration Date:2010-12-21
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)