MEDICARE: CYNTHIA H HALE LPC

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	101YP2500X	Professional Counselor	0701003298	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	219934	OTHER	VA	ANTHEM

General Provider Information

NPI Number	:	1578503447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA H HALE LPC

Provider Business Mailing Address
First Line	:	PO BOX 810
Second Line	:
City	:	CEDAR BLUFF
State	:	VA
Zip	:	24609-0810
Country	:	US
Telephone Number	:	276-964-6702
Fax Number	:	276-964-5669

Provider Business Practice Location Address
First Line	:	RT 19 460
Second Line	:
City	:	CEDAR BLUFF
State	:	VA
Zip	:	24609
Country	:	US
Telephone Number	:	276-964-6702
Fax Number	:	276-964-5669

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	07/08/2007

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