MEDICARE: KYLIE HALL

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	LGP7784	MD
2	101YM0800X	Mental Health Counselor	LC10931	MD

General Provider Information

NPI Number	:	1699389668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLIE HALL

Provider Business Mailing Address
First Line	:	2 TOPAZ CT APT 2D
Second Line	:
City	:	ROSEDALE
State	:	MD
Zip	:	21237-1246
Country	:	US
Telephone Number	:	443-680-5879
Fax Number	:

Provider Business Practice Location Address
First Line	:	1726 WHITEHEAD RD
Second Line	:
City	:	WOODLAWN
State	:	MD
Zip	:	21207-4003
Country	:	US
Telephone Number	:	410-265-8737
Fax Number	:

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

Provider Enumeration Date	:	09/07/2020
Last Update Date	:	12/06/2022

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Directions to “ KYLIE HALL ” Practice Location

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