Healthcare Provider Details

I. General information

NPI: 1063063956
Provider Name (Legal Business Name): MELISSA LEE HALE MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 12/31/2023
Certification Date: 12/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10672 US HIGHWAY 61
JACKSON MO
63755-7171
US

IV. Provider business mailing address

PO BOX 100
POCAHONTAS MO
63779-0100
US

V. Phone/Fax

Practice location:
  • Phone: 573-837-7144
  • Fax: 636-333-4510
Mailing address:
  • Phone: 573-837-7144
  • Fax: 636-333-4510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2017038749
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: