MEDICARE: KEVIN R HALL LCSW LADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	01751L	NV

General Provider Information

NPI Number	:	1386154649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN R HALL LCSW LADC

Provider Business Mailing Address
First Line	:	3885 S DECATUR BLVD STE 3010
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-6814
Country	:	US
Telephone Number	:	702-875-6618
Fax Number	:	702-566-4575

Provider Business Practice Location Address
First Line	:	3885 S DECATUR BLVD STE 3010
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-6814
Country	:	US
Telephone Number	:	702-875-6618
Fax Number	:	702-566-4575

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2017
Last Update Date	:	10/01/2017

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