Healthcare Provider Details

I. General information

NPI: 1346908167
Provider Name (Legal Business Name): HEALE, A PROFESSIONAL LICENSED CLINICAL SOCIAL WORK CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 DOWNEY AVE
MODESTO CA
95354-1301
US

IV. Provider business mailing address

3848 MCHENRY AVE STE 135-123
MODESTO CA
95356-1586
US

V. Phone/Fax

Practice location:
  • Phone: 209-450-8037
  • Fax:
Mailing address:
  • Phone: 209-450-8037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. MELISSA HALE
Title or Position: PRESIDENT
Credential: LCSW
Phone: 209-450-8037