Provider Demographics
NPI:1912079849
Name:HALE, GREGORY THOMAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:THOMAS
Last Name:HALE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10291 N MERIDIAN ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1076
Mailing Address - Country:US
Mailing Address - Phone:317-844-5628
Mailing Address - Fax:317-844-9580
Practice Address - Street 1:10291 N MERIDIAN ST
Practice Address - Street 2:SUITE 180
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46290-1076
Practice Address - Country:US
Practice Address - Phone:317-844-5628
Practice Address - Fax:317-844-9580
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040436-A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INR32914Medicare UPIN
IN315240Medicare ID - Type Unspecified