Provider Demographics
NPI:1457119562
Name:HALE, KRISTIN JOY (LAC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:JOY
Last Name:HALE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7725 W LOWER BUCKEYE RD UNIT 1032
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-3334
Mailing Address - Country:US
Mailing Address - Phone:330-803-7434
Mailing Address - Fax:
Practice Address - Street 1:4414 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-4114
Practice Address - Country:US
Practice Address - Phone:623-688-4585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-22544101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health