Shirley Jean Hall, PSYCHOLOGIST

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY9836 Issued in FL

Practice address

4651 Salisbury Rd Ste 400
Jacksonville, FL 32256-6187

Phone

(904) 661-0020

Fax

(904) 337-4724

NPI assigned

Nov 30, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Shirley Jean Butts Former name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Baylor College of Medicine, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1512000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607299200000",
    "number": "1558875310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1948 MELROSE PLANTATION DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322235545",
            "telephone_number": "904-337-4289",
            "fax_number": "904-337-4724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4651 SALISBURY RD STE 400",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322566187",
            "telephone_number": "904-661-0020",
            "fax_number": "904-337-4724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALL",
        "first_name": "SHIRLEY",
        "middle_name": "JEAN",
        "credential": "PSYCHOLOGIST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-11-30",
        "last_updated": "2020-12-07",
        "certification_date": "2020-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY9836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHIRLEY",
            "last_name": "BUTTS",
            "middle_name": "JEAN",
            "credential": "PHD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nordeka Hall
• Renadia Cherie Hall
• Ritisha Dionne Hall, LMT
• Samantha Hall
• Sheri Frances Hall, APRN
• Sommer C Hall, PT
• Tia Iman Sojourner Hall, BEHAVIORAL TECH
• Tiffany Angela Hall
• Hall's Way Transportation LLC
• Jonah Michael Hallahan, DPT

• Clinical Psychologist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.