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General NPI Number Information
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NPI Number | 1467234641
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Entity Type | Individual
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Provider Name | MR. TRIPP LANE HALL
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Gender | Male
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Dates
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Enumeration Date | 10/20/2023
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Last Update Date | 10/20/2023
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Provider Practice Location Address
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Address Line | 602 N BROADWAY ST
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City | TECUMSEH
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State | OK
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Zip | 74873-2020
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Country | US
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Telephone | 405-585-3777
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Fax |
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Provider Business Mailing Address
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Address Line | 702 W WOOD ST
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City | SHAWNEE
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State | OK
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Zip | 74801-4705
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Country | US
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Telephone | 405-585-3777
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 11811
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License Number State | OK
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