Provider Demographics
NPI:1659314201
Name:HALES, JASON A (LCSW)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:A
Last Name:HALES
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 1:65 N MAIN ST
Mailing Address - Street 2:UNIT 667
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-2217
Mailing Address - Country:US
Mailing Address - Phone:801-783-9265
Mailing Address - Fax:
Practice Address - Street 1:36 N MAIN ST
Practice Address - Street 2:12
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2100
Practice Address - Country:US
Practice Address - Phone:801-783-9265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4979280-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT219792803501001OtherBCBS ID # INDIVIDUAL
UTB0930Medicaid
UT219792803501001OtherBCBS ID # INDIVIDUAL
UTB0930Medicaid
UT000057729Medicare PIN