Provider Demographics
NPI:1629080379
Name:HALL-POLUS, BONNIE (PHD)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:HALL-POLUS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 W 2ND ST
Mailing Address - Street 2:STE 207
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-9002
Mailing Address - Country:US
Mailing Address - Phone:859-255-4864
Mailing Address - Fax:859-255-5385
Practice Address - Street 1:535 W 2ND ST
Practice Address - Street 2:STE 207
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-9002
Practice Address - Country:US
Practice Address - Phone:859-255-4864
Practice Address - Fax:859-255-5385
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY960103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling