Provider Demographics
NPI:1275934143
Name:HALL, DEBORAH KATHERINE (MA, ATR-BC, LPCC)
Entity Type:Individual
Prefix:MISS
First Name:DEBORAH
Middle Name:KATHERINE
Last Name:HALL
Suffix:
Gender:F
Credentials:MA, ATR-BC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 PASEO CORAZON LN
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-3636
Mailing Address - Country:US
Mailing Address - Phone:270-300-1920
Mailing Address - Fax:
Practice Address - Street 1:1121 PASEO CORAZON LN
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507
Practice Address - Country:US
Practice Address - Phone:270-300-1920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0190771101YP2500X, 101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM76588831Medicaid