Healthcare Provider Details

I. General information

NPI: 1992129902
Provider Name (Legal Business Name): MARY KAY HALL, MSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2014
Last Update Date: 02/21/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 SOUTH ARTHUR STREET, #515
SPOKANE WA
99202-2204
US

IV. Provider business mailing address

140 SOUTH ARTHUR STREET, #515
SPOKANE WA
99202-2204
US

V. Phone/Fax

Practice location:
  • Phone: 509-343-3321
  • Fax: 509-343-3323
Mailing address:
  • Phone: 509-343-3321
  • Fax: 509-343-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number00008827
License Number StateWA

VIII. Authorized Official

Name: MARY KAY HALL
Title or Position: MSW, LLC
Credential: MSW
Phone: 509-343-3321