Provider Demographics
NPI:1588725295
Name:GERALD HALL LLC
Entity type:Organization
Organization Name:GERALD HALL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEATISHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DUBOSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-351-0242
Mailing Address - Street 1:102 SW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-3810
Mailing Address - Country:US
Mailing Address - Phone:580-351-0242
Mailing Address - Fax:580-351-0282
Practice Address - Street 1:102 SW 12TH ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3810
Practice Address - Country:US
Practice Address - Phone:580-351-0242
Practice Address - Fax:580-351-0282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK789101YP2500X
OK562106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty