Provider Demographics
NPI:1467530717
Name:HALL, JAMES (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:HALL
Suffix:
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 1:900 E HARTFORD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-2011
Mailing Address - Country:US
Mailing Address - Phone:580-762-4103
Mailing Address - Fax:
Practice Address - Street 1:900 E HARTFORD AVE STE A
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-2011
Practice Address - Country:US
Practice Address - Phone:580-762-4103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK200438101YP1600X
OK2141246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other