Provider Demographics
NPI:1992129902
Name:MARY KAY HALL, MSW, LLC
Entity type:Organization
Organization Name:MARY KAY HALL, MSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MSW, LLC
Authorized Official - Prefix:
Authorized Official - First Name:MARY KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:509-343-3321
Mailing Address - Street 1:140 SOUTH ARTHUR STREET, #515
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2204
Mailing Address - Country:US
Mailing Address - Phone:509-343-3321
Mailing Address - Fax:509-343-3323
Practice Address - Street 1:140 SOUTH ARTHUR STREET, #515
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2204
Practice Address - Country:US
Practice Address - Phone:509-343-3321
Practice Address - Fax:509-343-3323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00008827261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA=========OtherEIN