Provider Demographics
NPI:1093051211
Name:HALL, MILDRED M (PLPC)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:M
Last Name:HALL
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:EL DORADO SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64744
Mailing Address - Country:US
Mailing Address - Phone:417-876-5314
Mailing Address - Fax:417-876-5328
Practice Address - Street 1:107 W BROADWAY
Practice Address - Street 2:
Practice Address - City:EL DORADO SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64744
Practice Address - Country:US
Practice Address - Phone:417-876-5314
Practice Address - Fax:417-876-5328
Is Sole Proprietor?:No
Enumeration Date:2012-12-15
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012040862101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional