Provider Demographics
NPI:1114073384
Name:HALL, ELIZABETH ANN (PHDAND MSW)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:HALL
Suffix:
Gender:F
Credentials:PHDAND MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5460 WARD RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-1825
Mailing Address - Country:US
Mailing Address - Phone:303-431-5641
Mailing Address - Fax:303-467-1145
Practice Address - Street 1:5460 WARD RD
Practice Address - Street 2:SUITE 210
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-1825
Practice Address - Country:US
Practice Address - Phone:303-431-5641
Practice Address - Fax:303-467-1145
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9892611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO86856Medicare ID - Type Unspecified