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General NPI Number Information
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NPI Number | 1285231266
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Entity Type | Individual
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Provider Name | BETHANY A HALL TLLP
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Gender | Female
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Dates
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Enumeration Date | 10/03/2020
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Last Update Date | 10/03/2020
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Provider Practice Location Address
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Address Line | 6060 DIXIE HWY STE H
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City | CLARKSTON
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State | MI
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Zip | 48346-3476
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Country | US
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Telephone | 248-270-5395
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Fax |
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Provider Business Mailing Address
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Address Line | 730 S DAYTON ST
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City | DAVISON
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State | MI
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Zip | 48423-1716
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Country | US
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Telephone | 810-333-3860
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6362009122
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License Number State | MI
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