Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1405 | OR |
Y | 103T00000X | Psychologist | 1405 | OR |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 1405 | OR |
N | 103G00000X | Clinical Psychologist | 1405 | OR |
N | 103TC0700X | Clinical Psychologist | 1405 | OR |
N | 103TC1900X | Counseling Psychologist | 1405 | OR |
N | 103TP2701X | Group Psychotherapist | 1405 | OR |
NPI | 1053405753 |
---|---|
Provider Name | Dr. Jean E Hale |
First Address | Gold Beach, OR 97444 |
Second Address | Gold Beach, OR 97444 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 19/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12792 | (02) | OR |
262371 | (05) | OR |