Provider Demographics
NPI:1447651310
Name:HALLBROOKS, LANDON DERRICK (MSW)
Entity type:Individual
Prefix:MR
First Name:LANDON
Middle Name:DERRICK
Last Name:HALLBROOKS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7896
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-7896
Mailing Address - Country:US
Mailing Address - Phone:951-850-1574
Mailing Address - Fax:
Practice Address - Street 1:435 W MISSION BLVD STE 301
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-1632
Practice Address - Country:US
Practice Address - Phone:951-850-1574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2019-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW886761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical