Provider Demographics
NPI:1457345472
Name:HALL, THOMAS CARROLL (MSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:CARROLL
Last Name:HALL
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1175
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85299-1175
Mailing Address - Country:US
Mailing Address - Phone:480-926-1826
Mailing Address - Fax:480-926-1162
Practice Address - Street 1:1201 S ALMA SCHOOL RD
Practice Address - Street 2:SUITE 11750
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-2008
Practice Address - Country:US
Practice Address - Phone:480-926-1826
Practice Address - Fax:480-926-1162
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-00171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ229595OtherOTHER PROVIDER ID
AZLCSW-0017OtherSTATE LICENCE
AZ229595OtherOTHER PROVIDER ID