Healthcare Provider Details

I. General information

NPI: 1245692359
Provider Name (Legal Business Name): MICHAEL HALL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9620 CAREYS RUN POND CREEK ROAD
MCDERMOTT OH
45652
US

IV. Provider business mailing address

PO BOX 402
WHEELERSBURG OH
45694-0402
US

V. Phone/Fax

Practice location:
  • Phone: 740-858-6683
  • Fax:
Mailing address:
  • Phone: 740-858-6683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.004914
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: