Provider Demographics
NPI:1073659090
Name:HALE, DIANNE FARRELL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:FARRELL
Last Name:HALE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2366 SUNNYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1449
Mailing Address - Country:US
Mailing Address - Phone:801-583-5044
Mailing Address - Fax:801-585-5845
Practice Address - Street 1:650 KOMAS DR
Practice Address - Street 2:SUITE 217-A
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1215
Practice Address - Country:US
Practice Address - Phone:801-581-6250
Practice Address - Fax:801-585-5845
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT140233-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT140233-3501OtherL.C.S.W.