Provider Demographics
NPI:1023664331
Name:HALL, TRINITY MICHAEL I
Entity type:Individual
Prefix:MR
First Name:TRINITY
Middle Name:MICHAEL
Last Name:HALL
Suffix:I
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 1:19217 36TH AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5751
Mailing Address - Country:US
Mailing Address - Phone:657-444-9002
Mailing Address - Fax:
Practice Address - Street 1:12760 W 87TH STREET PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-2878
Practice Address - Country:US
Practice Address - Phone:667-444-9002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSRBT-19-95553106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician