Provider Demographics
NPI:1154781094
Name:HALL, MALLORY (LPC)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1067 FM 306 STE 6307
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6897
Mailing Address - Country:US
Mailing Address - Phone:830-837-5550
Mailing Address - Fax:210-352-9575
Practice Address - Street 1:1067 FM 306 STE 607
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6897
Practice Address - Country:US
Practice Address - Phone:830-837-5550
Practice Address - Fax:210-352-9575
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-04
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70536101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX355955103Medicaid