Healthcare Provider Details

I. General information

NPI: 1275985491
Provider Name (Legal Business Name): CASEY HALL LPC, LMFT-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 ALCOA RD
BENTON AR
72015-3404
US

IV. Provider business mailing address

622 ALCOA RD
BENTON AR
72015-3404
US

V. Phone/Fax

Practice location:
  • Phone: 501-205-4570
  • Fax: 877-728-0820
Mailing address:
  • Phone: 918-809-2509
  • Fax: 877-728-0820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberM1701012
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP1607084
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: