MEDICARE: MRS. CAROLINE LOWRY HALL MA, LPC

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	L2534798	MI
2	101YS0200X	School Counselor	CC-WYW950030016	MI

General Provider Information

NPI Number	:	1396178562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLINE LOWRY HALL MA, LPC

Provider Business Mailing Address
First Line	:	4467 CASCADE RD SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-3776
Country	:	US
Telephone Number	:	616-818-6678
Fax Number	:	616-956-3020

Provider Business Practice Location Address
First Line	:	4467 CASCADE RD SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-3776
Country	:	US
Telephone Number	:	616-690-7319
Fax Number	:	616-956-3020

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

Provider Enumeration Date	:	08/12/2013
Last Update Date	:	06/17/2020

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