Healthcare Provider Details

I. General information

NPI: 1619762861
Provider Name (Legal Business Name): SELENA MARIE HALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 COHASSET RD STE 185
CHICO CA
95926-2460
US

IV. Provider business mailing address

PO BOX 3298
CLEARLAKE CA
95422-3298
US

V. Phone/Fax

Practice location:
  • Phone: 530-552-5058
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberF4301886
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: