Provider Demographics
NPI:1013479567
Name:HALE, KRISTIE MARIE (LMFT)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:MARIE
Last Name:HALE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 MICHAELS RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CTY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-9799
Mailing Address - Country:US
Mailing Address - Phone:573-291-7772
Mailing Address - Fax:
Practice Address - Street 1:3220 MICHAELS RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CTY
Practice Address - State:MO
Practice Address - Zip Code:65101-9799
Practice Address - Country:US
Practice Address - Phone:573-291-7772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024012933106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist