Provider Demographics
NPI:1184779324
Name:HALL, GERALD DWAYNE (LMFT)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:DWAYNE
Last Name:HALL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3813 SE CAMELOT DR
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-8420
Mailing Address - Country:US
Mailing Address - Phone:580-355-2261
Mailing Address - Fax:
Practice Address - Street 1:102 SW 12TH ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3810
Practice Address - Country:US
Practice Address - Phone:580-351-0242
Practice Address - Fax:580-351-0282
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK789101YP2500X
OK562106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist