Healthcare Provider Details

I. General information

NPI: 1043126600
Provider Name (Legal Business Name): JODY HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3746 E AMITY AVE STE 104
NAMPA ID
83687-1220
US

IV. Provider business mailing address

3746 E AMITY AVE STE 104
NAMPA ID
83687-1220
US

V. Phone/Fax

Practice location:
  • Phone: 208-495-6055
  • Fax:
Mailing address:
  • Phone: 208-495-6055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3681309
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: