Healthcare Provider Details

I. General information

NPI: 1922459684
Provider Name (Legal Business Name): CARLOS RAY HALE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E FOOTHILL BLVD STE 300
PASADENA CA
91107-7102
US

IV. Provider business mailing address

2500 E FOOTHILL BLVD STE 300
PASADENA CA
91107-7102
US

V. Phone/Fax

Practice location:
  • Phone: 626-993-3000
  • Fax:
Mailing address:
  • Phone: 626-993-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number131173
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number102044
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: