Provider Demographics
NPI:1932989852
Name:HALL, BRADY (MA, EDS)
Entity Type:Individual
Prefix:
First Name:BRADY
Middle Name:
Last Name:HALL
Suffix:
Gender:M
Credentials:MA, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 S OAK ST
Mailing Address - Street 2:ST 301
Mailing Address - City:WINCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:47394
Mailing Address - Country:US
Mailing Address - Phone:765-584-7602
Mailing Address - Fax:
Practice Address - Street 1:325 S OAK ST
Practice Address - Street 2:ST 301
Practice Address - City:WINCHESTER
Practice Address - State:IN
Practice Address - Zip Code:47394
Practice Address - Country:US
Practice Address - Phone:765-584-7602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10322353103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool