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General NPI Number Information
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NPI Number | 1578881918
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Entity Type | Organization
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Legal Business Name | HALES COUNSELING CENTER, PLLC
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Dates
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Enumeration Date | 05/10/2010
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Last Update Date | 03/03/2014
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Provider Practice Location Address
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Address Line | 36 N MAIN ST 12
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City | TOOELE
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State | UT
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Zip | 84074-2100
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Country | US
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Telephone | 801-783-9265
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Fax |
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Provider Business Mailing Address
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Address Line | 65 N MAIN ST UNIT 667
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City | TOOELE
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State | UT
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Zip | 84074-2217
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Country | US
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Telephone | 801-783-9265
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JASON A HALES
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Credential | LCSW
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Telephone | 801-783-9265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 75934640162
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License Number State | UT
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