Provider Demographics
NPI:1952741027
Name:HALL, MISTI LYNN (LMFT)
Entity Type:Individual
Prefix:
First Name:MISTI
Middle Name:LYNN
Last Name:HALL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5580 ECTON RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-9626
Mailing Address - Country:US
Mailing Address - Phone:772-538-7174
Mailing Address - Fax:502-808-6041
Practice Address - Street 1:19 WAINSCOTT AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1970
Practice Address - Country:US
Practice Address - Phone:772-538-7174
Practice Address - Fax:502-808-6041
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2016-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY168307106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist