Provider Demographics
NPI:1326719618
Name:HALL, BRANDY LORRAINE (AMFT, APCC)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:LORRAINE
Last Name:HALL
Suffix:
Gender:F
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:LORRAINE
Other - Last Name:CANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21143 HAWTHORNE BLVD # 357
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4615
Mailing Address - Country:US
Mailing Address - Phone:424-703-5338
Mailing Address - Fax:
Practice Address - Street 1:1828 ROYAL OAKS DR
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-1954
Practice Address - Country:US
Practice Address - Phone:424-703-5338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-25
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9868101YP2500X
CA126661106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional