Provider Demographics
NPI:1790917607
Name:HALE, SCOTT B (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:B
Last Name:HALE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12222 S 1000 E STE 3
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-3203
Mailing Address - Country:US
Mailing Address - Phone:801-987-3592
Mailing Address - Fax:
Practice Address - Street 1:12222 S 1000 E STE 3
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-3203
Practice Address - Country:US
Practice Address - Phone:801-987-3592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT340722-35011041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC322842Medicaid
SC3000641104OtherWORKER'S COMP
SC3347Medicare PIN