Provider Demographics
NPI:1659412740
Name:HALL, MARY ANNE (MA MFT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANNE
Last Name:HALL
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-1602
Mailing Address - Country:US
Mailing Address - Phone:805-541-4036
Mailing Address - Fax:805-528-4520
Practice Address - Street 1:1408 3RD ST
Practice Address - Street 2:
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-1602
Practice Address - Country:US
Practice Address - Phone:805-541-4036
Practice Address - Fax:805-528-4520
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 32505101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health