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General NPI Number Information
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NPI Number | 1518479690
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Entity Type | Individual
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Provider Name | KRISTA HALES
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Gender | Female
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Dates
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Enumeration Date | 10/30/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 2290 MCDANIEL ST STE 1C
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89030-6329
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Country | US
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Telephone | 702-399-1600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 897
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City | BOISE
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State | ID
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Zip | 83701-0897
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 01638-L
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License Number State | NV
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