Healthcare Provider Details

I. General information

NPI: 1326766635
Provider Name (Legal Business Name): CIARA P HALE AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 GRAND AVE
SACRAMENTO CA
95838-3466
US

IV. Provider business mailing address

811 GRAND AVE
SACRAMENTO CA
95838-3466
US

V. Phone/Fax

Practice location:
  • Phone: 916-922-9868
  • Fax:
Mailing address:
  • Phone: 916-922-9868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number144581
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: