=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942545371
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW W. HALL LCPC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2012
-----------------------------------------------------
Last Update Date | 09/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 567 MAIN STREET
-----------------------------------------------------
City | EAST MACHIAS
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-726-8474
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 8
-----------------------------------------------------
City | EAST MACHIAS
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04630-0008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-726-8474
-----------------------------------------------------
Fax | 888-518-2282
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | CC4421
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------