Provider Demographics
NPI:1699841643
Name:HALL, CHERYL LYNN (PHD, MSCP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:HALL
Suffix:
Gender:F
Credentials:PHD, MSCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 20TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1405
Mailing Address - Country:US
Mailing Address - Phone:806-441-2940
Mailing Address - Fax:806-498-1642
Practice Address - Street 1:3021 20TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1405
Practice Address - Country:US
Practice Address - Phone:806-441-2940
Practice Address - Fax:806-498-1642
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25300103TC0700X
NMPSY1696103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096861202Medicaid
TX0071AWMedicare PIN