MEDICARE: MRS. MARY JACLYN HALE LMSW

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	1041C0700X	Clinical Social Worker	106698	TX

General Provider Information

NPI Number	:	1275240996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY JACLYN HALE LMSW

Provider Business Mailing Address
First Line	:	1042 W 25TH ST UNIT D
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1880
Country	:	US
Telephone Number	:	713-298-2991
Fax Number	:

Provider Business Practice Location Address
First Line	:	1042 W 25TH ST UNIT D
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1880
Country	:	US
Telephone Number	:	281-908-8176
Fax Number	:

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

Provider Enumeration Date	:	11/02/2022
Last Update Date	:	04/08/2026

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