Provider Demographics
NPI:1821365396
Name:HALLING, BECKY JO (LADC)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:JO
Last Name:HALLING
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 7TH ST NE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-3644
Mailing Address - Country:US
Mailing Address - Phone:507-535-5666
Mailing Address - Fax:507-287-1465
Practice Address - Street 1:29 7TH ST NE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-3644
Practice Address - Country:US
Practice Address - Phone:507-535-5666
Practice Address - Fax:507-287-1465
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303005101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)