Provider Demographics
NPI:1811355530
Name:FALL, KEVIN (PHD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:FALL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N MUR LEN RD
Mailing Address - Street 2:SUITE 12A
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-5431
Mailing Address - Country:US
Mailing Address - Phone:913-440-9545
Mailing Address - Fax:
Practice Address - Street 1:601 N MUR LEN RD
Practice Address - Street 2:SUITE 12A
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-5431
Practice Address - Country:US
Practice Address - Phone:913-284-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2360103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist