Provider Demographics
NPI:1326418500
Name:HALL, JON (LAC, LPC)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:HALL
Suffix:
Gender:M
Credentials:LAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 E 5TH ST
Mailing Address - Street 2:P.O. BOX 711
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-2206
Mailing Address - Country:US
Mailing Address - Phone:316-283-6743
Mailing Address - Fax:316-283-6830
Practice Address - Street 1:6723 STATE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-3020
Practice Address - Country:US
Practice Address - Phone:913-871-7600
Practice Address - Fax:913-328-0339
Is Sole Proprietor?:No
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS747101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)