Provider Demographics
NPI:1568673598
Name:HALL, JAY ANTHONY (LCSW, SAP)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:ANTHONY
Last Name:HALL
Suffix:
Gender:M
Credentials:LCSW, SAP
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:ANTHONY
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:117 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-9020
Mailing Address - Country:US
Mailing Address - Phone:502-510-3630
Mailing Address - Fax:
Practice Address - Street 1:1908 N MILES ST
Practice Address - Street 2:SUITE 103
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8916
Practice Address - Country:US
Practice Address - Phone:502-510-3630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY14121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical