Doctor Name: | MR. DOUGLAS HALES |
NPI Number: | 1144676537 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMFT |
License Number: | MFC27832 |
Business Practice Address: | 211 Culver Blvd Ste P Playa Del Rey, CA - 902937776 |
Business Phone Number: | 3234204653 |
Business Fax Number: | |
Mailing Address: | 211 Culver Blvd Ste P, PLAYA DEL REY |
State: | CA |
Postal Code: | 902937776 |
Phone Number: | 3234204653 |
Fax Number: | |
NPI Enumeration Date: | 05/04/2016 |
NPI Last Update Date: | 05/04/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MFC27832 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |