Individual
MR. JASON A HALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
36 N MAIN ST, 12, TOOELE, UT 84074-2100
(801) 783-9265
Mailing address
65 N MAIN ST, UNIT 667, TOOELE, UT 84074-2217
(801) 783-9265
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4979280-3501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
219792803501001
BCBS ID # INDIVIDUAL
UT
05
—
B0930
—
UT
Enumeration date
06/13/2006
Last updated
03/03/2014
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