| Reva K B O'hallarn | |
|
708 Mobjack Pl Newport News VA 23606-1957 | |
| (757) 873-1958 | |
| (757) 873-2143 |
| Full Name | Reva K B O'hallarn |
|---|---|
| Speciality | Psychologist |
| Location | 708 Mobjack Pl, Newport News, Virginia |
| Authorized Official Name and Position | Reva K B O'hallarn (SOLE MEMBER) |
| Authorized Official Contact | 7578731958 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Reva K B O'hallarn 708 Mobjack Pl Newport News VA 23606-1957 Ph: (757) 873-1958 | Reva K B O'hallarn 708 Mobjack Pl Newport News VA 23606-1957 Ph: (757) 873-1958 |
| NPI Number | 1255688495 |
|---|---|
| Provider Enumeration Date | 08/07/2012 |
| Last Update Date | 08/07/2012 |
| Medicare PECOS PAC ID | 9739331851 |
|---|---|
| Medicare Enrollment ID | O20121218000143 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255688495 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 0810003845 (Virginia) | Primary |
| Provider Name | Reva K B O Hallarn |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1427245588 PECOS PAC ID: 8022165414 Enrollment ID: I20121218000112 |
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