Healthcare Provider Details

I. General information

NPI: 1639684376
Provider Name (Legal Business Name): KIRSTIN TAYLOR HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2017
Last Update Date: 02/15/2026
Certification Date: 02/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 13TH ST
SAINT CLOUD FL
34769-4531
US

IV. Provider business mailing address

5490 SILVER THISTLE LN
SAINT CLOUD FL
34772-6849
US

V. Phone/Fax

Practice location:
  • Phone: 407-556-3411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH28692
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: