Provider Demographics
NPI:1427164490
Name:HALL, JOHN BENNER (MSW)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:BENNER
Last Name:HALL
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2659 W GUADALUPE
Mailing Address - Street 2:C-220
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202
Mailing Address - Country:US
Mailing Address - Phone:480-839-0951
Mailing Address - Fax:480-345-9864
Practice Address - Street 1:2659 W GUADALUPE
Practice Address - Street 2:C-220
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202
Practice Address - Country:US
Practice Address - Phone:480-839-0951
Practice Address - Fax:480-345-9864
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW20841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical