Provider Demographics
NPI:1386154649
Name:HALL, KEVIN R (LCSW LADC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:R
Last Name:HALL
Suffix:
Gender:M
Credentials:LCSW LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3885 S DECATUR BLVD STE 3010
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-6814
Mailing Address - Country:US
Mailing Address - Phone:702-875-6618
Mailing Address - Fax:702-566-4575
Practice Address - Street 1:3885 S DECATUR BLVD STE 3010
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-6814
Practice Address - Country:US
Practice Address - Phone:702-875-6618
Practice Address - Fax:702-566-4575
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-01
Last Update Date:2017-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01751L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)