Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 20041241A | IN |
N | 103TC0700X | Clinical Psychologist | 20041241A | IN |
N | 103G00000X | Clinical Psychologist | 20041241A | IN |
N | 103TC0700X | Clinical Psychologist | 20041241A | IN |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 20041241A | IN |
NPI | 1104944669 |
---|---|
Provider Name | Dr. Carl Stanley Hale |
First Address | Merrillville, IN 46410 |
Second Address | Merrillville, IN 46410-5431 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 08/07/2007 |