Provider Demographics
NPI:1053822718
Name:HALL, JOHN L (PLMHP, PLADC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:HALL
Suffix:
Gender:M
Credentials:PLMHP, PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9633 HOLLOW TREE DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-9535
Mailing Address - Country:US
Mailing Address - Phone:402-817-7312
Mailing Address - Fax:
Practice Address - Street 1:4600 VALLEY RD STE 425
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4855
Practice Address - Country:US
Practice Address - Phone:402-817-7312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-20
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1126101YA0400X
NE11611101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)