Healthcare Provider Details

I. General information

NPI: 1871455329
Provider Name (Legal Business Name): RIO HALE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 2ND AVE S
KETCHUM ID
83340
US

IV. Provider business mailing address

PO BOX 533
KETCHUM ID
83340-0481
US

V. Phone/Fax

Practice location:
  • Phone: 208-450-5645
  • Fax: 208-247-4987
Mailing address:
  • Phone: 208-450-5645
  • Fax: 208-247-4987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: