Provider Demographics
NPI:1316646144
Name:HALL, COURTNEY (MA, LPC-IT)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:MA, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4540 S 124TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-2482
Mailing Address - Country:US
Mailing Address - Phone:414-595-2849
Mailing Address - Fax:
Practice Address - Street 1:N91W17194 APPLETON AVE STE 204
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-2083
Practice Address - Country:US
Practice Address - Phone:414-622-0420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-01
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7286-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health