Healthcare Provider Details

I. General information

NPI: 1336293810
Provider Name (Legal Business Name): TOM J. HALL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9504 ADMIRAL NIMITZ AVE NE
ALBUQUERQUE NM
87111-1324
US

IV. Provider business mailing address

9504 ADMIRAL NIMITZ AVE NE
ALBUQUERQUE NM
87111-1324
US

V. Phone/Fax

Practice location:
  • Phone: 505-856-5191
  • Fax: 505-332-9165
Mailing address:
  • Phone: 505-856-5191
  • Fax: 505-332-9165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberI-05304
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: