Provider Demographics
NPI:1376160630
Name:GOTTFRIED, HAL F
Entity Type:Individual
Prefix:
First Name:HAL
Middle Name:F
Last Name:GOTTFRIED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14655 W 141ST ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-6584
Mailing Address - Country:US
Mailing Address - Phone:913-944-6531
Mailing Address - Fax:
Practice Address - Street 1:14655 W 141ST ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-6584
Practice Address - Country:US
Practice Address - Phone:913-440-4670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty