Provider Demographics
NPI:1851498851
Name:HALL, MARYKAY (MSW, LLCORMSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:MARYKAY
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:MSW, LLCORMSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 S. ARTHUR STREET, SUITE #515
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2204
Mailing Address - Country:US
Mailing Address - Phone:509-343-3321
Mailing Address - Fax:509-343-3323
Practice Address - Street 1:140 S. ARTHUR STREET, SUITE #515
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2204
Practice Address - Country:US
Practice Address - Phone:509-343-3321
Practice Address - Fax:509-343-3323
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000088271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW00008827OtherWASHINGTON LICENSE
WALW00008827OtherWASHINGTON LICENSE