Provider Demographics
NPI:1861703290
Name:HALL, LANCE M (LCSW)
Entity type:Individual
Prefix:MR
First Name:LANCE
Middle Name:M
Last Name:HALL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 TUACAHN DR UNIT 43
Mailing Address - Street 2:
Mailing Address - City:IVINS
Mailing Address - State:UT
Mailing Address - Zip Code:84738-6191
Mailing Address - Country:US
Mailing Address - Phone:435-669-4848
Mailing Address - Fax:
Practice Address - Street 1:140 TUACAHN DR UNIT 43
Practice Address - Street 2:
Practice Address - City:IVINS
Practice Address - State:UT
Practice Address - Zip Code:84738-6191
Practice Address - Country:US
Practice Address - Phone:435-669-4848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5199649-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health