Provider Demographics
NPI:1225777253
Name:HALL, MARY (LM, CPM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 COUNTY ROAD 2160
Mailing Address - Street 2:
Mailing Address - City:TELEPHONE
Mailing Address - State:TX
Mailing Address - Zip Code:75488-3485
Mailing Address - Country:US
Mailing Address - Phone:254-459-1643
Mailing Address - Fax:
Practice Address - Street 1:653 COUNTY ROAD 2160
Practice Address - Street 2:
Practice Address - City:TELEPHONE
Practice Address - State:TX
Practice Address - Zip Code:75488-3485
Practice Address - Country:US
Practice Address - Phone:254-459-1643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-28
Last Update Date:2022-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99484176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife