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General NPI Number Information
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NPI Number | 1952926867
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Entity Type | Individual
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Provider Name | ANGELA HALL
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Gender | Female
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Dates
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Enumeration Date | 06/16/2020
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Last Update Date | 06/16/2020
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Provider Practice Location Address
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Address Line | 220 MOUNT MERCY DR # 4
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City | PEWEE VALLEY
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State | KY
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Zip | 40056-8024
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Country | US
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Telephone | 502-939-9728
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Fax |
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Provider Business Mailing Address
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Address Line | 1902 PITTYPAT RUN
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City | LA GRANGE
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State | KY
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Zip | 40031-8970
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Country | US
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Telephone | 502-939-9728
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 260584
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License Number State | KY
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