Provider Demographics
NPI:1447292297
Name:HALL, DOUGLAS KEITH (LCSW)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:KEITH
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:PO BOX 192506
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-8521
Mailing Address - Country:US
Mailing Address - Phone:214-662-3523
Mailing Address - Fax:972-404-4441
Practice Address - Street 1:2214 BOLL ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-2694
Practice Address - Country:US
Practice Address - Phone:214-662-3523
Practice Address - Fax:972-404-4441
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30749101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148771203Medicaid
TX00959FMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER