Provider Demographics
NPI:1801333794
Name:HALL, ANTHONY
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:HALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 YOUREE DR
Mailing Address - Street 2:STE. 301
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-3661
Mailing Address - Country:US
Mailing Address - Phone:318-210-0928
Mailing Address - Fax:318-425-9644
Practice Address - Street 1:2800 YOUREE DR
Practice Address - Street 2:STE. 301
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-3661
Practice Address - Country:US
Practice Address - Phone:318-210-0928
Practice Address - Fax:318-425-9644
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health