Provider Demographics
NPI:1467503508
Name:HALE, HEATHER M (PSYD, LCPC, CADC)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:M
Last Name:HALE
Suffix:
Gender:F
Credentials:PSYD, LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 NORTH SHORE DRIVE
Mailing Address - Street 2:SUITE NO. 174
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-2243
Mailing Address - Country:US
Mailing Address - Phone:847-615-1698
Mailing Address - Fax:847-615-1697
Practice Address - Street 1:900 NORTH SHORE DRIVE
Practice Address - Street 2:SUITE NO. 174
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-2243
Practice Address - Country:US
Practice Address - Phone:847-615-1698
Practice Address - Fax:847-615-1697
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL21668101YA0400X
IL101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4932337OtherBC BS IL. PROVIDER NUMBER