Healthcare Provider Details

I. General information

NPI: 1245855436
Provider Name (Legal Business Name): HALLE MEDLEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 09/27/2023
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8924 KANIS RD
LITTLE ROCK AR
72205-6414
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 501-455-2712
  • Fax: 501-455-2781
Mailing address:
  • Phone: 870-347-2534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2212002
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: