Healthcare Provider Details

I. General information

NPI: 1922606763
Provider Name (Legal Business Name): ERIC JEFFREY HALES LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 E 5600 S STE 105
MURRAY UT
84107-6180
US

IV. Provider business mailing address

881 W BAXTER DR STE 100
SOUTH JORDAN UT
84095-8506
US

V. Phone/Fax

Practice location:
  • Phone: 801-995-9534
  • Fax:
Mailing address:
  • Phone: 801-995-9534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11743559-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: