Provider Demographics
NPI:1235244005
Name:HALE, GREGORY A (NCP, LMHC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:A
Last Name:HALE
Suffix:
Gender:M
Credentials:NCP, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2738 E. 00 NS
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-6631
Mailing Address - Country:US
Mailing Address - Phone:765-236-1964
Mailing Address - Fax:765-326-1960
Practice Address - Street 1:2738 E. 00 NS
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-6631
Practice Address - Country:US
Practice Address - Phone:765-236-1964
Practice Address - Fax:765-326-1960
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000223A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200958980AMedicaid
IN000000390318OtherANTHEM PIN