Provider Demographics
NPI:1295010064
Name:HALL, SUSAN RAE (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:RAE
Last Name:HALL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:RAE
Other - Last Name:DUNHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:1011 W MAPLE ST STE 400
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-5806
Mailing Address - Country:US
Mailing Address - Phone:269-353-7607
Mailing Address - Fax:269-888-2260
Practice Address - Street 1:1011 W MAPLE ST STE 400
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-5806
Practice Address - Country:US
Practice Address - Phone:269-353-7607
Practice Address - Fax:269-888-2260
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010856101YP2500X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No251S00000XAgenciesCommunity/Behavioral Health