MEDICARE: CATHERINE ELLEN HALLAM

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	101YM0800X	Mental Health Counselor	20346	AZ

General Provider Information

NPI Number	:	1639703747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE ELLEN HALLAM

Provider Business Mailing Address
First Line	:	8433 N BLACK CANYON HWY
Second Line	:	STE 100-14
City	:	PHOENIX
State	:	TN
Zip	:	85338
Country	:	US
Telephone Number	:	865-738-7901
Fax Number	:

Provider Business Practice Location Address
First Line	:	8433 N BLACK CANYON HWY STE 100-14
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-4873
Country	:	US
Telephone Number	:	865-738-7901
Fax Number	:

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

Provider Enumeration Date	:	02/27/2020
Last Update Date	:	07/31/2023

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Directions to “ CATHERINE ELLEN HALLAM ” Practice Location

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