Provider Demographics
NPI:1801948716
Name:HALE, MYRA MOJICA (MA, MHP, CDP, AAC)
Entity type:Individual
Prefix:
First Name:MYRA
Middle Name:MOJICA
Last Name:HALE
Suffix:
Gender:F
Credentials:MA, MHP, CDP, AAC
Other - Prefix:
Other - First Name:MAYANG
Other - Middle Name:JOJICA
Other - Last Name:HALE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1600 E OLIVE ST
Mailing Address - Street 2:SOUND MENTAL HEALTH
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2735
Mailing Address - Country:US
Mailing Address - Phone:206-302-2200
Mailing Address - Fax:206-302-2210
Practice Address - Street 1:6100 SOUTHCENTER BLVD
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2441
Practice Address - Country:US
Practice Address - Phone:206-444-7820
Practice Address - Fax:206-444-7810
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60150535101YM0800X, 101YP2500X, 101YM0800X
WACP00006375101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional