Provider Demographics
NPI:1588922884
Name:HALLSTROM, AARON DAVID (PHD, LIAC)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:DAVID
Last Name:HALLSTROM
Suffix:
Gender:M
Credentials:PHD, LIAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 S ALMA SCHOOL RD STE A203
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3066
Mailing Address - Country:US
Mailing Address - Phone:480-256-8566
Mailing Address - Fax:
Practice Address - Street 1:1930 S ALMA SCHOOL RD STE A203
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3066
Practice Address - Country:US
Practice Address - Phone:480-256-8566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11698101YA0400X
AZ15102101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)