MEDICARE: SHELBY HALE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1073163911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY HALE LPC

Provider Business Mailing Address
First Line	:	PO BOX 742
Second Line	:
City	:	EAGLE POINT
State	:	OR
Zip	:	97524-0742
Country	:	US
Telephone Number	:	541-826-8282
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 GARFIELD ST APT 13
Second Line	:
City	:	ASHLAND
State	:	OR
Zip	:	97520-3945
Country	:	US
Telephone Number	:	541-826-8282
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2019
Last Update Date	:	12/08/2023

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Directions to “ SHELBY HALE LPC” Practice Location

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