Provider Demographics
NPI:1508168329
Name:HALL, JIMMIE L (MSW)
Entity Type:Individual
Prefix:
First Name:JIMMIE
Middle Name:L
Last Name:HALL
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1830
Mailing Address - Street 2:
Mailing Address - City:SHIPROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87420-1830
Mailing Address - Country:US
Mailing Address - Phone:505-368-1438
Mailing Address - Fax:505-368-1452
Practice Address - Street 1:PINON AND COTTONWOOD DRIVE BLDG 2301
Practice Address - Street 2:
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420-1830
Practice Address - Country:US
Practice Address - Phone:505-368-1438
Practice Address - Fax:505-368-1452
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NMCSA0185301101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health