Brian Arthur Haesloop

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

A06960315 Issued in CA

Practice address

3990 Industrial Blvd
West Sacramento, CA 95691-3430

Phone

(916) 796-0020

Fax

(916) 796-0045

NPI assigned

Sep 11, 2009

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1252627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631836800000",
    "number": "1336472117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2501 LOS FELIZ WAY",
            "city": "CARMICHAEL",
            "state": "CA",
            "postal_code": "956085344",
            "telephone_number": "916-402-9185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3990 INDUSTRIAL BLVD",
            "city": "WEST SACRAMENTO",
            "state": "CA",
            "postal_code": "956913430",
            "telephone_number": "916-796-0020",
            "fax_number": "916-796-0045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAESLOOP",
        "first_name": "BRIAN",
        "middle_name": "ARTHUR",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-09-11",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "A06960315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Counselor in West Sacramento, CA
• Providers in West Sacramento, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.