Provider Demographics
NPI:1669501300
Name:HALL, JEBEDIAH MORGAN (MA)
Entity Type:Individual
Prefix:
First Name:JEBEDIAH
Middle Name:MORGAN
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 1:3950 MERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:96022-9419
Mailing Address - Country:US
Mailing Address - Phone:530-209-8481
Mailing Address - Fax:530-209-8481
Practice Address - Street 1:857 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-2721
Practice Address - Country:US
Practice Address - Phone:530-209-8481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT112513106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist