Provider Demographics
NPI:1053407825
Name:HALL, MICHAEL J (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:HALL
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:543 TAYLOR AVENUE
Mailing Address - Street 2:DEPARTMENT OF MENTAL HEALTH AND BEHAVIORAL SCIENCES
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43203
Mailing Address - Country:US
Mailing Address - Phone:614-247-5420
Mailing Address - Fax:614-257-5418
Practice Address - Street 1:543 TAYLOR AVENUE
Practice Address - Street 2:DEPARTMENT OF MENTAL HEALTH AND BEHAVIORAL SCIENCES
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203
Practice Address - Country:US
Practice Address - Phone:614-247-5420
Practice Address - Fax:614-257-5418
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA19556103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical