MEDICARE: DONNA DANITA HALE MA CBT CHT

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	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1122334455	OTHER		UNITED HEALTHCARE

General Provider Information

NPI Number	:	1265068589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA DANITA HALE MA CBT CHT

Provider Business Mailing Address
First Line	:	1 BLACKFIELD DR
Second Line	:
City	:	TIBURON
State	:	CA
Zip	:	94920-2053
Country	:	US
Telephone Number	:	415-408-8839
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 BLACKFIELD DR
Second Line	:
City	:	TIBURON
State	:	CA
Zip	:	94920-2053
Country	:	US
Telephone Number	:	415-408-8829
Fax Number	:

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

Provider Enumeration Date	:	03/18/2020
Last Update Date	:	03/18/2020

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