Healthcare Provider Details

I. General information

NPI: 1750257598
Provider Name (Legal Business Name): LILLY ZIPORAH HALE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6220 CAMPBELL RD STE 102
DALLAS TX
75248-1394
US

IV. Provider business mailing address

6220 CAMPBELL RD STE 102
DALLAS TX
75248-1394
US

V. Phone/Fax

Practice location:
  • Phone: 469-623-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number92699
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: