Provider Demographics
NPI:1508322736
Name:HALL, CHRISTOPHER SHANE
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:SHANE
Last Name:HALL
Suffix:
Gender:M
Credentials:
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 147
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-0147
Mailing Address - Country:US
Mailing Address - Phone:907-942-1294
Mailing Address - Fax:
Practice Address - Street 1:916 E REZANOF DR
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6724
Practice Address - Country:US
Practice Address - Phone:907-486-3995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician