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NPI Code Detail

MEDICARE: MRS. NADEAH BRIANNE HALL TLLP

MEDICARE: MRS. NADEAH BRIANNE HALL TLLP
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
1103T00000XPsychologist6361008288MI

General Provider Information

NPI Number : 1700630019
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NADEAH BRIANNE HALL TLLP
Provider Business Mailing Address
First Line : 8245 HOLLY RD STE 200
Second Line :
City : GRAND BLANC
State : MI
Zip : 48439-2483
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8245 HOLLY RD STE 200
Second Line :
City : GRAND BLANC
State : MI
Zip : 48439-2483
Country : US
Telephone Number : 810-242-3740
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2024
Last Update Date : 01/11/2026

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