1457345472 NPI number — MR. THOMAS CARROLL HALL M.S.W.

Table of content: MR. THOMAS CARROLL HALL M.S.W. (NPI 1457345472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457345472 NPI number — MR. THOMAS CARROLL HALL M.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALL
Provider First Name:
THOMAS
Provider Middle Name:
CARROLL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.S.W.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457345472
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1175
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85299-1175
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-926-1826
Provider Business Mailing Address Fax Number:
480-926-1162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 S ALMA SCHOOL RD
Provider Second Line Business Practice Location Address:
SUITE 11750
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85210-2008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-926-1826
Provider Business Practice Location Address Fax Number:
480-926-1162
Provider Enumeration Date:
09/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCSW-0017 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 229595 . This is a "OTHER PROVIDER ID" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: LCSW-0017 . This is a "STATE LICENCE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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