Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | I-05304 | NM |
N | 225C00000X | Rehabilitation Counselor |
NPI | 1336293810 |
---|---|
Provider Name | Mr. Tom J. Hall |
First Address | Albuquerque, NM 87111-1324 |
Second Address | Albuquerque, NM 87111-1324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
91005701 | (05) | NM |