MEDICARE: ABIGAIL HALL TLLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	6352000813	MI

General Provider Information

NPI Number	:	1023706165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL HALL TLLP

Provider Business Mailing Address
First Line	:	408 S MAIN ST
Second Line	:
City	:	BERRIEN SPRINGS
State	:	MI
Zip	:	49103-1225
Country	:	US
Telephone Number	:	269-982-3832
Fax Number	:

Provider Business Practice Location Address
First Line	:	9116 E 13TH ST
Second Line	:
City	:	CADILLAC
State	:	MI
Zip	:	49601-8126
Country	:	US
Telephone Number	:	231-878-3059
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2023
Last Update Date	:	04/26/2023

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