Healthcare Provider Details

I. General information

NPI: 1386154649
Provider Name (Legal Business Name): KEVIN R HALL LCSW LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2017
Last Update Date: 10/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3885 S DECATUR BLVD STE 3010
LAS VEGAS NV
89103-6814
US

IV. Provider business mailing address

3885 S DECATUR BLVD STE 3010
LAS VEGAS NV
89103-6814
US

V. Phone/Fax

Practice location:
  • Phone: 702-875-6618
  • Fax: 702-566-4575
Mailing address:
  • Phone: 702-875-6618
  • Fax: 702-566-4575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number01751L
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: