MEDICARE: MRS. ANDREA ANN HALL MA, LPC

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	101YP2500X	Professional Counselor	L1084155	MI

General Provider Information

NPI Number	:	1073739538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDREA ANN HALL MA, LPC

Provider Business Mailing Address
First Line	:	3153 W BEAL CITY RD
Second Line	:
City	:	WEIDMAN
State	:	MI
Zip	:	48893-9757
Country	:	US
Telephone Number	:	734-620-2743
Fax Number	:

Provider Business Practice Location Address
First Line	:	3153 W BEAL CITY RD
Second Line	:
City	:	WEIDMAN
State	:	MI
Zip	:	48893-9757
Country	:	US
Telephone Number	:	734-620-2743
Fax Number	:

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	10/07/2014

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