Healthcare Provider Details

I. General information

NPI: 1174555866
Provider Name (Legal Business Name): AMY SUSAN WEBER HALL PHD, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 BUTTERMILK PIKE STE 200
CRESCENT SPRINGS KY
41017-1696
US

IV. Provider business mailing address

7627 CLOUDSTONE DR
FLORENCE KY
41042-8058
US

V. Phone/Fax

Practice location:
  • Phone: 859-869-2023
  • Fax:
Mailing address:
  • Phone: 513-604-8596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number284614
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number284614
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: