Basic Information
| Provider Information | |||||||||
| NPI: | 1972121838 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | LOUIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 102 SPRIGG ST | ||||||||
| Address2: | |||||||||
| City: | FRANKFORT | ||||||||
| State: | KY | ||||||||
| PostalCode: | 406018159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022294017 | ||||||||
| FaxNumber: | 8592773653 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 KINGS DAUGHTERS DR | ||||||||
| Address2: | |||||||||
| City: | FRANKFORT | ||||||||
| State: | KY | ||||||||
| PostalCode: | 406014242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026992885 | ||||||||
| FaxNumber: | 5026992890 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2020 | ||||||||
| LastUpdateDate: | 12/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 245164 | KY | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 171M00000X | KY | N | Other Service Providers | Case Manager/Care Coordinator | 101YA0400X | 272976 | KY | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.