Provider Demographics
NPI:1619152287
Name:HALL, GENE EDWARD (MA)
Entity Type:Individual
Prefix:
First Name:GENE
Middle Name:EDWARD
Last Name:HALL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2172 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-8566
Mailing Address - Country:US
Mailing Address - Phone:541-915-2925
Mailing Address - Fax:
Practice Address - Street 1:16811 SE MCGILLIVRAY BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-3404
Practice Address - Country:US
Practice Address - Phone:360-735-8100
Practice Address - Fax:360-253-1781
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2136101YP2500X
WALH60723485101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional