Provider Demographics
NPI:1346332319
Name:HALL, IRWIN III (PHD)
Entity Type:Individual
Prefix:DR
First Name:IRWIN
Middle Name:
Last Name:HALL
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-8319
Mailing Address - Country:US
Mailing Address - Phone:405-447-6188
Mailing Address - Fax:405-735-5265
Practice Address - Street 1:1922 N EASTERN AVE
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5605
Practice Address - Country:US
Practice Address - Phone:405-447-6188
Practice Address - Fax:405-735-5265
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK673101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health