Provider Demographics
NPI:1174108328
Name:HALL, THERESA (LMFT)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
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 1:5 BON AIR RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1137
Mailing Address - Country:US
Mailing Address - Phone:415-461-0440
Mailing Address - Fax:
Practice Address - Street 1:5 BON AIR RD STE 105
Practice Address - Street 2:
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1137
Practice Address - Country:US
Practice Address - Phone:415-461-0440
Practice Address - Fax:415-461-3792
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35002106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist