Provider Demographics
NPI:1760561534
Name:HALL, BRUCE VERNON (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:VERNON
Last Name:HALL
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 COMANCHE TRL
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-8105
Mailing Address - Country:US
Mailing Address - Phone:318-396-6747
Mailing Address - Fax:318-396-6759
Practice Address - Street 1:3703 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7434
Practice Address - Country:US
Practice Address - Phone:318-396-6747
Practice Address - Fax:318-396-6759
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA313101YM0800X, 101YP2500X
LA317106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist