Provider Demographics
NPI:1710907340
Name:HALL, THOMAS ARNOLD (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ARNOLD
Last Name:HALL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 SUNRISE AVE STE 5
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4678
Mailing Address - Country:US
Mailing Address - Phone:209-571-2733
Mailing Address - Fax:209-527-6754
Practice Address - Street 1:1608 SUNRISE AVE STE 5
Practice Address - Street 2:SUITE 5
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4678
Practice Address - Country:US
Practice Address - Phone:209-571-2733
Practice Address - Fax:209-527-6754
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13196103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL131960Medicare ID - Type UnspecifiedPROVIDER NUMBER