Healthcare Provider Details

I. General information

NPI: 1154281749
Provider Name (Legal Business Name): MS. MARLA GAYE HALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2025
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11653 VIRGINIA PKWY
CALDWELL ID
83605-7928
US

IV. Provider business mailing address

11653 VIRGINIA PKWY
CALDWELL ID
83605-7928
US

V. Phone/Fax

Practice location:
  • Phone: 208-999-5432
  • Fax:
Mailing address:
  • Phone: 208-999-5432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: