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General NPI Number Information
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NPI Number | 1619110921
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Entity Type | Organization
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Legal Business Name | HALLA-BAUER PSYCHOLOGICAL SERVICES CORPORATION
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Dates
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Enumeration Date | 04/16/2009
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Last Update Date | 04/16/2009
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Provider Practice Location Address
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Address Line | 300 MEDICAL DR SUITE 705
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City | LAGRANGE
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State | GA
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Zip | 30240-4130
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Country | US
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Telephone | 706-885-0111
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Fax | 706-885-0607
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Provider Business Mailing Address
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Address Line | 300 MEDICAL DR SUITE 705
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City | LAGRANGE
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State | GA
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Zip | 30240-4130
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Country | US
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Telephone | 706-885-0111
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Fax | 706-885-0607
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Authorized Official
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Title or Position | PSYCHOLOGIST/OWNER
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Name | HEIDI ANN HALLA-BAUER
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Credential | PSYD
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Telephone | 706-885-0111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY003092
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License Number State | GA
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