Provider Demographics
NPI:1871025759
Name:HALE, MARTHA (BCBA)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:HALE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 HENDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630
Mailing Address - Country:US
Mailing Address - Phone:409-883-2273
Mailing Address - Fax:409-883-2274
Practice Address - Street 1:807 HENDERSON AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630
Practice Address - Country:US
Practice Address - Phone:409-883-2273
Practice Address - Fax:409-883-2274
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-16-22530103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst