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General NPI Number Information
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NPI Number | 1457764599
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Entity Type | Individual
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Provider Name | GEORGE HALLETT M.ED.
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Gender | Male
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Dates
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Enumeration Date | 06/06/2014
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Last Update Date | 06/06/2014
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Provider Practice Location Address
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Address Line | 115 S LUDLOW ST
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City | DAYTON
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State | OH
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Zip | 45402-1812
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Country | US
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Telephone | 937-542-3312
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Fax |
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Provider Business Mailing Address
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Address Line | 31 RUE ROYALE APT J
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City | KETTERING
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State | OH
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Zip | 45429-1474
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Country | US
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Telephone |
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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 | UDI-00-4587
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License Number State | OH
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