MEDICARE: KRISTA HALES

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	01638-L	NV

General Provider Information

NPI Number	:	1518479690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA HALES

Provider Business Mailing Address
First Line	:	PO BOX 897
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83701-0897
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2290 MCDANIEL ST STE 1C
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-6329
Country	:	US
Telephone Number	:	702-399-1600
Fax Number	:

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

Provider Enumeration Date	:	10/30/2017
Last Update Date	:	03/17/2018

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Directions to “ KRISTA HALES ” Practice Location

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