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General NPI Number Information
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NPI Number | 1215675186
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Entity Type | Individual
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Provider Name | MRS. DEBORAH J HALL
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Gender | Female
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Dates
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Enumeration Date | 05/21/2022
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Last Update Date | 05/21/2022
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Provider Practice Location Address
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Address Line | 1562 GOLDEN OAKS LOOP S
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City | SOUTHAVEN
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State | MS
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Zip | 38671-6194
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Country | US
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Telephone | 901-338-0234
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Fax |
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Provider Business Mailing Address
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Address Line | 1562 GOLDEN OAKS LOOP S
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City | SOUTHAVEN
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State | MS
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Zip | 38671-6194
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Country | US
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Telephone | 901-338-0234
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-20-113481
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License Number State |
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