Provider Demographics
NPI:1689952145
Name:HALL, GREGORY N (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:N
Last Name:HALL
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2273 S VISTA AVE
Mailing Address - Street 2:STE. 190
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-7341
Mailing Address - Country:US
Mailing Address - Phone:208-343-2737
Mailing Address - Fax:208-342-3238
Practice Address - Street 1:2273 S VISTA AVE
Practice Address - Street 2:STE. 190
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-7341
Practice Address - Country:US
Practice Address - Phone:208-343-2737
Practice Address - Fax:208-342-3238
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4738101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional