Provider Demographics
NPI:1528185626
Name:RANDOLPH HALL, CRYSTAL ANN
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ANN
Last Name:RANDOLPH HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:ANN
Other - Last Name:RANDOLPH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:436 DEAN AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-3413
Mailing Address - Country:US
Mailing Address - Phone:541-915-0770
Mailing Address - Fax:
Practice Address - Street 1:1790 W 11TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3758
Practice Address - Country:US
Practice Address - Phone:541-868-0661
Practice Address - Fax:541-868-0660
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health