Provider Demographics
NPI:1518182435
Name:HALL, FRED (LPC, LMFT)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:HALL
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-4204
Mailing Address - Country:US
Mailing Address - Phone:601-955-0649
Mailing Address - Fax:601-974-6260
Practice Address - Street 1:1225 N STATE ST
Practice Address - Street 2:MAW SUITE 210
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2064
Practice Address - Country:US
Practice Address - Phone:601-973-1697
Practice Address - Fax:601-974-6260
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS2058298OtherAETNA PROVIDER NUMBER