Provider Demographics
NPI:1306321617
Name:HALLAUER, CALEB JOHN (MA, T-LMLP)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:JOHN
Last Name:HALLAUER
Suffix:
Gender:M
Credentials:MA, T-LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 NW REDBUD CIR APT 2
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66617-1898
Mailing Address - Country:US
Mailing Address - Phone:785-236-9703
Mailing Address - Fax:
Practice Address - Street 1:2619 W 6TH ST STE C
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4300
Practice Address - Country:US
Practice Address - Phone:785-830-8299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2880103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical