Provider Demographics
NPI:1255997987
Name:HALL, AUSTIN (LCPC, CADC, NCC)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:HALL
Suffix:
Gender:M
Credentials:LCPC, CADC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:0N032 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1014
Mailing Address - Country:US
Mailing Address - Phone:630-903-3829
Mailing Address - Fax:
Practice Address - Street 1:2942 W LAKE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-1924
Practice Address - Country:US
Practice Address - Phone:773-796-2186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL33794101YA0400X
IL180.012260101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)