Healthcare Provider Details

I. General information

NPI: 1568197002
Provider Name (Legal Business Name): JENNIFER LYNNE HALL LSAA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1732 SAVANNAH DR NE
RIO RANCHO NM
87144-5701
US

IV. Provider business mailing address

1732 SAVANNAH DR NE
RIO RANCHO NM
87144-5701
US

V. Phone/Fax

Practice location:
  • Phone: 818-521-1685
  • Fax:
Mailing address:
  • Phone: 818-521-1685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2022-0235
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2022-0321
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: