Provider Demographics
NPI:1982733549
Name:HALL, MARILYN
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 HWY. 101 #316
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-7634
Mailing Address - Country:US
Mailing Address - Phone:626-780-9562
Mailing Address - Fax:909-912-8017
Practice Address - Street 1:625 HWY. 101 #316
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-7634
Practice Address - Country:US
Practice Address - Phone:626-780-9562
Practice Address - Fax:909-912-8017
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT2116106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty