Basic Information
| Provider Information | |||||||||
| NPI: | 1417485285 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | EDRICK | ||||||||
| MiddleName: | LYLE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 531 HEIDRICH ST | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770184524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328653493 | ||||||||
| FaxNumber: | 7139707246 | ||||||||
| Practice Location | |||||||||
| Address1: | 531 HEIDRICH ST | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770184524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328653493 | ||||||||
| FaxNumber: | 7139707246 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2017 | ||||||||
| LastUpdateDate: | 08/30/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 74381 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.