Provider Demographics
NPI:1023393287
Name:HALL, BRYAN TODD (LCSW)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:TODD
Last Name:HALL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4532 DAWSON DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7026
Mailing Address - Country:US
Mailing Address - Phone:501-612-4150
Mailing Address - Fax:
Practice Address - Street 1:4532 DAWSON DR
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7026
Practice Address - Country:US
Practice Address - Phone:501-612-4150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1379-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical