Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 0083571 | NM |
N | 101YP1600X | Pastoral Counselor | 0083571 | NM |
N | 101YP2500X | Professional Counselor | 0083571 | NM |
NPI | 1063684637 |
---|---|
Provider Name | Breda Faye Hall |
First Address | Brandon, MS 39043-1643 |
Second Address | Madison, MS 39110-7469 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2008 |
Last Update Date | 18/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01-0877337 | DEPT. OF TREASURY, IRS (01) | MS |