Healthcare Provider Details

I. General information

NPI: 1366671828
Provider Name (Legal Business Name): STACEY HALL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 E CEDAR ST SUITE 115
OLATHE KS
66062-1891
US

IV. Provider business mailing address

1715 E CEDAR ST SUITE 115
OLATHE KS
66062-1891
US

V. Phone/Fax

Practice location:
  • Phone: 816-977-3178
  • Fax: 816-572-6838
Mailing address:
  • Phone: 816-977-3178
  • Fax: 816-572-6838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4008
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number3935
License Number StateKS

VIII. Authorized Official

Name: STACEY HALL
Title or Position: OWNER
Credential: LSCSW
Phone: 816-977-3178