MEDICARE: MR. JOHN BURTON HALL I LADC, CADC

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	000097	VT

General Provider Information

NPI Number	:	1912086224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN BURTON HALL I LADC, CADC

Provider Business Mailing Address
First Line	:	73 MAIN ST
Second Line	:	TREATMENT ASSOCIATES SUITE 39
City	:	MONTPELIER
State	:	VT
Zip	:	05602-2932
Country	:	US
Telephone Number	:	802-223-6732
Fax Number	:	802-225-1318

Provider Business Practice Location Address
First Line	:	73 MAIN ST
Second Line	:	TREATMENT ASSOCIATES SUITE 39
City	:	MONTPELIER
State	:	VT
Zip	:	05602-2932
Country	:	US
Telephone Number	:	802-223-6732
Fax Number	:	802-225-1318

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/08/2007

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