Provider Demographics
NPI:1720389091
Name:HALLAM, DORIS MARIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:MARIE
Last Name:HALLAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DORIS
Other - Middle Name:MARIE
Other - Last Name:HALLAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:625 MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:MO
Mailing Address - Zip Code:63080-1537
Mailing Address - Country:US
Mailing Address - Phone:573-468-2121
Mailing Address - Fax:573-468-6121
Practice Address - Street 1:625 MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:MO
Practice Address - Zip Code:63080-1537
Practice Address - Country:US
Practice Address - Phone:573-468-2121
Practice Address - Fax:573-468-6121
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008012437101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101Y00000XOtherNPI