Healthcare Provider Details

I. General information

NPI: 1497049068
Provider Name (Legal Business Name): COURTNEY PATRICK HALL LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 S MAIN CROSS ST
LOUISA KY
41230-1065
US

IV. Provider business mailing address

125 S MAIN CROSS ST
LOUISA KY
41230-1065
US

V. Phone/Fax

Practice location:
  • Phone: 606-638-0938
  • Fax:
Mailing address:
  • Phone: 606-638-0938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number104453
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: