Provider Demographics
NPI:1275765513
Name:HALL PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:HALL PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:920-882-5300
Mailing Address - Street 1:103 W COLLEGE AVE
Mailing Address - Street 2:SUITE 611
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5770
Mailing Address - Country:US
Mailing Address - Phone:920-882-5300
Mailing Address - Fax:920-882-0747
Practice Address - Street 1:103 W COLLEGE AVE
Practice Address - Street 2:SUITE 611
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-5770
Practice Address - Country:US
Practice Address - Phone:920-882-5300
Practice Address - Fax:920-882-0747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2719-057261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)