Provider Demographics
NPI:1710185368
Name:HALL, TIMOTHY SHAWN (MED, NCC, LPCA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:SHAWN
Last Name:HALL
Suffix:
Gender:M
Credentials:MED, NCC, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4643 HIGHWAY 899
Mailing Address - Street 2:
Mailing Address - City:PIPPA PASSES
Mailing Address - State:KY
Mailing Address - Zip Code:41844-9033
Mailing Address - Country:US
Mailing Address - Phone:606-634-0179
Mailing Address - Fax:
Practice Address - Street 1:4643 HIGHWAY 899
Practice Address - Street 2:
Practice Address - City:PIPPA PASSES
Practice Address - State:KY
Practice Address - Zip Code:41844-9033
Practice Address - Country:US
Practice Address - Phone:606-634-0179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0581101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health