Provider Demographics
NPI:1679922991
Name:HALL, JACI N (LMFT)
Entity type:Individual
Prefix:MS
First Name:JACI
Middle Name:N
Last Name:HALL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3716 E CHURCH ROCKS DR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-5001
Mailing Address - Country:US
Mailing Address - Phone:435-705-9213
Mailing Address - Fax:
Practice Address - Street 1:1490 E FOREMASTER DR STE 340
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4506
Practice Address - Country:US
Practice Address - Phone:435-216-9290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF 1000005106H00000X
UT10977758-3902106H00000X
OHF1000005106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist