Provider Demographics
NPI:1083927800
Name:HALES, JAMIE LEA (LCSW)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEA
Last Name:HALES
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 1:825 N 300 W
Mailing Address - Street 2:SUITE N221
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-1459
Mailing Address - Country:US
Mailing Address - Phone:801-824-0827
Mailing Address - Fax:
Practice Address - Street 1:825 N 300 W
Practice Address - Street 2:N221
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-1459
Practice Address - Country:US
Practice Address - Phone:801-824-0827
Practice Address - Fax:801-823-4584
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6619461-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT00023954Medicaid