Provider Demographics
NPI:1700804283
Name:HALES, CATHERINE ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN
Last Name:HALES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 WYNDGATE MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63367-4341
Mailing Address - Country:US
Mailing Address - Phone:573-406-7333
Mailing Address - Fax:
Practice Address - Street 1:691 TRADE CENTER BLVD STE B
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1279
Practice Address - Country:US
Practice Address - Phone:573-406-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0226651041C0700X
MOSW0009671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO493453914Medicaid