Healthcare Provider Details

I. General information

NPI: 1649098930
Provider Name (Legal Business Name): LONDON HALL LMFT- ASSOCIATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 HILLWOOD PKWY STE 140
FORT WORTH TX
76177-1532
US

IV. Provider business mailing address

PO BOX 77175
FORT WORTH TX
76177-0175
US

V. Phone/Fax

Practice location:
  • Phone: 682-233-4406
  • Fax:
Mailing address:
  • Phone: 682-233-4406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number98199
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number205694
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: