Healthcare Provider Details

I. General information

NPI: 1063980977
Provider Name (Legal Business Name): KAREN HALL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 VILLAGE DR
PAGOSA SPRINGS CO
81147-8368
US

IV. Provider business mailing address

185 SUTTLE ST
DURANGO CO
81303-8276
US

V. Phone/Fax

Practice location:
  • Phone: 970-264-2104
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW.0009922284
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09926716
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: