Provider Demographics
NPI:1255653523
Name:HALE, ETHAN FELIX (LPC; CVE)
Entity Type:Individual
Prefix:MR
First Name:ETHAN
Middle Name:FELIX
Last Name:HALE
Suffix:
Gender:M
Credentials:LPC; CVE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:MANITOU
Mailing Address - State:OK
Mailing Address - Zip Code:73555-0128
Mailing Address - Country:US
Mailing Address - Phone:405-820-5845
Mailing Address - Fax:
Practice Address - Street 1:202 EAST FOURTH
Practice Address - Street 2:
Practice Address - City:MANITOU
Practice Address - State:OK
Practice Address - Zip Code:73555
Practice Address - Country:US
Practice Address - Phone:405-820-5845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3905101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health