Individual
CLIVE RUSSELL HALLAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
19 E ABARR DR, PUEBLO WEST, CO 81007-5436
(435) 817-0155
Mailing address
PO BOX 7425, PUEBLO WEST, CO 81007-0425
(435) 817-0155
(307) 885-5206
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LMFT 134
WY
106H00000X
Marriage & Family Therapist
Primary
0001268
CO
106H00000X
Marriage & Family Therapist
8971102-3902
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
48800074
—
CO
Enumeration date
05/21/2008
Last updated
01/18/2021
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