Healthcare Provider Details

I. General information

NPI: 1104542992
Provider Name (Legal Business Name): MADISON HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2136 CUTLER ST
SIMI VALLEY CA
93065-4923
US

IV. Provider business mailing address

1672 CASARIN AVE
SIMI VALLEY CA
93065-4515
US

V. Phone/Fax

Practice location:
  • Phone: 805-527-1166
  • Fax: 805-527-1133
Mailing address:
  • Phone: 805-522-4891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number14646
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: