MEDICARE: KRISTIE MARIE HALE LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	2024012933	MO
2	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1013479567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIE MARIE HALE LMFT

Provider Business Mailing Address
First Line	:	3220 MICHAELS RD
Second Line	:
City	:	JEFFERSON CTY
State	:	MO
Zip	:	65101-9799
Country	:	US
Telephone Number	:	573-291-7772
Fax Number	:

Provider Business Practice Location Address
First Line	:	3220 MICHAELS RD
Second Line	:
City	:	JEFFERSON CTY
State	:	MO
Zip	:	65101-9799
Country	:	US
Telephone Number	:	573-291-7772
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2019
Last Update Date	:	08/14/2024

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