Provider Demographics
NPI:1063501138
Name:HALL, JUDITH CAROL (RN,MA,LPC)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:CAROL
Last Name:HALL
Suffix:
Gender:F
Credentials:RN,MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 NEWGATE RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-2713
Mailing Address - Country:US
Mailing Address - Phone:269-207-8162
Mailing Address - Fax:269-241-9336
Practice Address - Street 1:5380 HOLIDAY TER
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2154
Practice Address - Country:US
Practice Address - Phone:269-207-8162
Practice Address - Fax:269-341-9336
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009210101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional