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General NPI Number Information
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NPI Number | 1588752638
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Entity Type | Individual
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Provider Name | BRENT ALAN HALE L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 17707 STUDEBAKER RD SUITE # 208
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City | CERRITOS
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State | CA
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Zip | 90703-2640
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Country | US
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Telephone | 562-402-0677
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Fax | 562-467-7478
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Provider Business Mailing Address
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Address Line | 216 ROSWELL AVE
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City | LONG BEACH
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State | CA
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Zip | 90803-1535
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Country | US
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Telephone | 562-856-4420
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS 17256
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License Number State | CA
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