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General NPI Number Information
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NPI Number | 1073061628
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Entity Type | Individual
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Provider Name | ANTHONY GRANT HALL M.COUN., L.P.C.
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Gender | Male
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Dates
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Enumeration Date | 09/13/2016
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Last Update Date | 09/13/2016
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Provider Practice Location Address
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Address Line | 5185 W OVERLAND RD
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City | BOISE
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State | ID
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Zip | 83705-2635
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Country | US
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Telephone | 208-866-7376
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Fax |
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Provider Business Mailing Address
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Address Line | 12629 W ROSEGLEN CT
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City | BOISE
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State | ID
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Zip | 83713-1437
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Country | US
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Telephone | 208-866-7376
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC-5402
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-5402
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License Number State | ID
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