Provider Demographics
NPI:1699841643
Name:HALL, CHERYL LYNN (PHD, MS PSYPHARM)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:HALL
Suffix:
Gender:F
Credentials:PHD, MS PSYPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7021 KEWANEE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-7048
Mailing Address - Country:US
Mailing Address - Phone:806-763-0173
Mailing Address - Fax:806-763-8047
Practice Address - Street 1:7021 KEWANEE
Practice Address - Street 2:7 - 101
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-7049
Practice Address - Country:US
Practice Address - Phone:806-687-1884
Practice Address - Fax:806-794-3733
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25300103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096861202Medicaid
TX0071AWMedicare PIN