Provider Demographics
NPI:1326234352
Name:HALL, JEAN CAMILLE (PHD)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:CAMILLE
Last Name:HALL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 SW HOOK FARM DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-1410
Mailing Address - Country:US
Mailing Address - Phone:865-591-9177
Mailing Address - Fax:865-591-9177
Practice Address - Street 1:2103 SW HOOK FARM DR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64082-1410
Practice Address - Country:US
Practice Address - Phone:865-591-9177
Practice Address - Fax:865-591-9177
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20240167711041C0700X
ARC-13051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical