Healthcare Provider Details

I. General information

NPI: 1073112058
Provider Name (Legal Business Name): AMELIA C HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S OLIVE ST
LOS ANGELES CA
90012-4900
US

IV. Provider business mailing address

225 S OLIVE ST APT 1211
LOS ANGELES CA
90012-4997
US

V. Phone/Fax

Practice location:
  • Phone: 510-637-9202
  • Fax:
Mailing address:
  • Phone: 510-637-9202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number133430
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number115268
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: