Provider Demographics
NPI:1881128676
Name:KIRSTIN HALL
Entity type:Organization
Organization Name:KIRSTIN HALL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:619-871-5126
Mailing Address - Street 1:9257 LAKE MURRAY BLVD
Mailing Address - Street 2:UNIT D
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-1400
Mailing Address - Country:US
Mailing Address - Phone:619-871-5126
Mailing Address - Fax:888-616-0864
Practice Address - Street 1:9257 LAKE MURRAY BLVD
Practice Address - Street 2:UNIT D
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-1400
Practice Address - Country:US
Practice Address - Phone:619-871-5126
Practice Address - Fax:888-616-0864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty