Provider Demographics
NPI:1679759187
Name:HALL, MOLLY LYON (LCPC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:LYON
Last Name:HALL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 W DIVERSEY AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1245
Mailing Address - Country:US
Mailing Address - Phone:773-888-2016
Mailing Address - Fax:888-519-4215
Practice Address - Street 1:3411 W DIVERSEY AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-1245
Practice Address - Country:US
Practice Address - Phone:773-888-2016
Practice Address - Fax:888-519-4215
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009281101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health