Provider Demographics
NPI:1396208211
Name:HALL, JUDITH ELIZABETH (PHD, LMHC)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ELIZABETH
Last Name:HALL
Suffix:
Gender:F
Credentials:PHD, LMHC
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 1163
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-1163
Mailing Address - Country:US
Mailing Address - Phone:808-280-9363
Mailing Address - Fax:808-242-1469
Practice Address - Street 1:105 N MARKET ST STE 102
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1752
Practice Address - Country:US
Practice Address - Phone:808-344-5738
Practice Address - Fax:808-242-1469
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC-583101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional