Provider Demographics
NPI:1073636544
Name:TRICE, HALL H III (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:HALL
Middle Name:H
Last Name:TRICE
Suffix:III
Gender:M
Credentials:MA, LPC
Other - Prefix:MR
Other - First Name:HARRY
Other - Middle Name:HALL
Other - Last Name:TRICE
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:2615 S LIZZIE LN
Mailing Address - Street 2:
Mailing Address - City:ROCHEPORT
Mailing Address - State:MO
Mailing Address - Zip Code:65279-9454
Mailing Address - Country:US
Mailing Address - Phone:573-356-1904
Mailing Address - Fax:573-445-2238
Practice Address - Street 1:2615 S LIZZIE LN
Practice Address - Street 2:
Practice Address - City:ROCHEPORT
Practice Address - State:MO
Practice Address - Zip Code:65279-9454
Practice Address - Country:US
Practice Address - Phone:573-356-1904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2016-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS001926101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist