Healthcare Provider Details

I. General information

NPI: 1396675898
Provider Name (Legal Business Name): COURTNEY ANN HALL LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

962 E MULLETT LAKE RD
INDIAN RIVER MI
49749-9122
US

IV. Provider business mailing address

962 E MULLETT LAKE RD
INDIAN RIVER MI
49749-9122
US

V. Phone/Fax

Practice location:
  • Phone: 734-474-4274
  • Fax:
Mailing address:
  • Phone: 734-474-4274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851121771
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: