Doctor Name: | MR. HAL J JARDINE |
NPI Number: | 1760696447 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.S. |
License Number: | |
Business Practice Address: | 630 N Front St Arco, ID - 832138756 |
Business Phone Number: | 2085278933 |
Business Fax Number: | 2085274481 |
Mailing Address: | 630 N Front St, ARCO |
State: | ID |
Postal Code: | 832138756 |
Phone Number: | 2085278933 |
Fax Number: | 2085274481 |
NPI Enumeration Date: | 05/10/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |