Basic Information
| Provider Information | |||||||||
| NPI: | 1851740492 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALE | ||||||||
| FirstName: | JASON | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3103 DIXIE HWY | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450151653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138924673 | ||||||||
| FaxNumber: | 5137371107 | ||||||||
| Practice Location | |||||||||
| Address1: | 36 N DETROIT ST | ||||||||
| Address2: | |||||||||
| City: | XENIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453852909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9376104673 | ||||||||
| FaxNumber: | 9377362615 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2016 | ||||||||
| LastUpdateDate: | 11/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | C.1400473 | OH | N | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | 110098 | OH | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | C.1400473 | OH | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | C.1400473 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.