MEDICARE: KOLTON GARRETT HALL MA, LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	81242	TX
2	101YM0800X	Mental Health Counselor	81242	TX

General Provider Information

NPI Number	:	1023619491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KOLTON GARRETT HALL MA, LPC, NCC

Provider Business Mailing Address
First Line	:	1704 NORTHBROOK LN
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75092-6020
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 TEAGUE DR STE 508
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75090-2656
Country	:	US
Telephone Number	:	903-265-8113
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2020
Last Update Date	:	08/25/2022

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