Provider Demographics
NPI:1356579015
Name:MCHALE, JEWEL (LCPC)
Entity type:Individual
Prefix:
First Name:JEWEL
Middle Name:
Last Name:MCHALE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1567 LISBON ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-3545
Mailing Address - Country:US
Mailing Address - Phone:207-777-1107
Mailing Address - Fax:207-777-1605
Practice Address - Street 1:1567 LISBON ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-3545
Practice Address - Country:US
Practice Address - Phone:207-777-1107
Practice Address - Fax:207-777-1605
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1050101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432786100OtherMAINECARE