MEDICARE: LISA JOY HALE LPC-S LCDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	11687	TX
2	101YP2500X	Professional Counselor	68270	TX

General Provider Information

NPI Number	:	1740626324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA JOY HALE LPC-S LCDC

Provider Business Mailing Address
First Line	:	8104 SPRING CYPRESS RD
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-3123
Country	:	US
Telephone Number	:	281-205-8786
Fax Number	:	832-559-1939

Provider Business Practice Location Address
First Line	:	8104 SPRING CYPRESS RD
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-3123
Country	:	US
Telephone Number	:	281-205-8786
Fax Number	:	832-559-1939

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

Provider Enumeration Date	:	05/22/2013
Last Update Date	:	08/25/2020

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