Provider Demographics
NPI:1639703747
Name:HALLAM, CATHERINE ELLEN
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ELLEN
Last Name:HALLAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8433 N BLACK CANYON HWY
Mailing Address - Street 2:STE 100-14
Mailing Address - City:PHOENIX
Mailing Address - State:TN
Mailing Address - Zip Code:85338
Mailing Address - Country:US
Mailing Address - Phone:865-738-7901
Mailing Address - Fax:
Practice Address - Street 1:8433 N BLACK CANYON HWY STE 100-14
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4873
Practice Address - Country:US
Practice Address - Phone:865-738-7901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20346101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty