Provider Demographics
NPI:1538137179
Name:HALES, MARY K (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:K
Last Name:HALES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 581017
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84158-1017
Mailing Address - Country:US
Mailing Address - Phone:801-359-6069
Mailing Address - Fax:801-359-6049
Practice Address - Street 1:1060 E 100 S
Practice Address - Street 2:SUITE L1
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1501
Practice Address - Country:US
Practice Address - Phone:801-359-6069
Practice Address - Fax:801-359-6049
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist