Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003095910 |
---|---|
Provider Name | Ms. Jordan Alexandra Hall |
First Address | San Luis Obispo, CA 93401-5039 |
Second Address | San Luis Obispo, CA 93401-5039 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2007 |
Last Update Date | 26/10/2007 |