MEDICARE: EMILY JUNE HALL L.A.D.C.

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	723-L	NV

General Provider Information

NPI Number	:	1558602821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY JUNE HALL L.A.D.C.

Provider Business Mailing Address
First Line	:	3729 SMOKING GUN CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-8227
Country	:	US
Telephone Number	:	702-689-1354
Fax Number	:

Provider Business Practice Location Address
First Line	:	3729 SMOKING GUN CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-8227
Country	:	US
Telephone Number	:	702-689-1354
Fax Number	:

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

Provider Enumeration Date	:	03/11/2013
Last Update Date	:	07/27/2016

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