=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174401699
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMANTHA LYNN HALL M.S., LPCA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2025
-----------------------------------------------------
Last Update Date | 08/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 FOXGLOVE DR STE 6
-----------------------------------------------------
City | MOUNT STERLING
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40353-9770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-743-4131
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 252 GATEWAY PARK CIR
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40511-8746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-553-9420
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 300484
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------