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General NPI Number Information
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NPI Number | 1720736374
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Entity Type | Organization
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Legal Business Name | HEALE, A PROFESSIONAL LICENSED CLINICAL SOCIAL WORK CORPORATION
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Dates
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Enumeration Date | 03/14/2022
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Last Update Date | 03/14/2022
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Provider Practice Location Address
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Address Line | 420 DOWNEY AVE
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City | MODESTO
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State | CA
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Zip | 95354-1301
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Country | US
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Telephone | 209-450-8037
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Fax |
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Provider Business Mailing Address
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Address Line | 3848 MCHENRY AVE STE 135-123
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City | MODESTO
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State | CA
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Zip | 95356-1586
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Country | US
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Telephone | 209-450-8037
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Fax |
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Authorized Official
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Title or Position | DIRECTOR, OWNER
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Name | MELISSA D HALE
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Credential | LCSW
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Telephone | 209-450-8037
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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 |
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License Number State |
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