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NPI Code Detail

MEDICARE: JAMES HALL LADC

MEDICARE: JAMES HALL LADC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor3000921MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
122893OTHERMNHP
284-61062OTHERMNUBH
357422KUOTHERMNBCBS

General Provider Information

NPI Number : 1972511434
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES HALL LADC
Provider Business Mailing Address
First Line : 1132 CENTRAL AVE NE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55413-1512
Country : US
Telephone Number : 612-977-1821
Fax Number : 612-236-1700
Provider Business Practice Location Address
First Line : 1132 CENTRAL AVE NE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55413-1512
Country : US
Telephone Number : 612-977-1821
Fax Number : 612-236-1700
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2006
Last Update Date : 08/05/2009

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Directions to “ JAMES HALL LADC” Practice Location

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