Provider Demographics
NPI:1477755890
Name:HALL, NANCY LYNN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LYNN
Last Name:HALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:LYNN
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1820 MEMORIAL DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4693
Mailing Address - Country:US
Mailing Address - Phone:931-553-4161
Mailing Address - Fax:931-553-4176
Practice Address - Street 1:1820 MEMORIAL DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4693
Practice Address - Country:US
Practice Address - Phone:931-553-4161
Practice Address - Fax:931-553-4176
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3920030Medicare PIN