Doctor Name: | MR. ETHAN FELIX HALE |
NPI Number: | 1255653523 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC; CVE |
License Number: | 3905 |
Business Practice Address: | 503 N Hudson St Altus, OK - 735213656 |
Business Phone Number: | 4058205845 |
Business Fax Number: | |
Mailing Address: | 503 N Hudson St, ALTUS |
State: | OK |
Postal Code: | 735213656 |
Phone Number: | 4058205845 |
Fax Number: | |
NPI Enumeration Date: | 02/26/2010 |
NPI Last Update Date: | 02/26/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 3905 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |