Provider Demographics
NPI:1104110543
Name:HALL, SHELLEY (LPC)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 JOE RAMSEY BLVD E STE 103A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-7762
Mailing Address - Country:US
Mailing Address - Phone:903-494-5771
Mailing Address - Fax:903-494-5772
Practice Address - Street 1:3101 JOE RAMSEY BLVD E STE 103A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7762
Practice Address - Country:US
Practice Address - Phone:903-494-5771
Practice Address - Fax:903-494-5772
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX82489101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health