Active NPI
Jean E Hale, PSY.D.
- Psychologist
- Gold Beach, OR
National Provider Identifier
1053405753
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1405
- Practice address
- 94174 10TH St.
Gold Beach, OR 97444 - Phone
- (541) 247-0678
- Fax
- (541) 247-0317
- NPI assigned
- Oct 3, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1405 | OR | Primary |
| Cognitive & Behavioral Psychologist | 103TB0200X | 1405 | OR | |
| Clinical Psychologist | 103TC0700X | 1405 | OR | |
| Counseling Psychologist | 103TC1900X | 1405 | OR | |
| Group Psychotherapy Psychologist | 103TP2701X | 1405 | OR |
Addresses
Primary practice location
94174 10TH St.
Gold Beach, OR 97444
Mailing address
P.O. Box 496
Gold Beach, OR 97444
Phone (541) 247-0678
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 262371 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1405 | OR | MD | Cognitive & Behavioral Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1263859200000",
"number": "1053405753",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 496",
"city": "GOLD BEACH",
"state": "OR",
"postal_code": "97444",
"telephone_number": "541-247-0678"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "94174 10TH ST.",
"city": "GOLD BEACH",
"state": "OR",
"postal_code": "97444",
"telephone_number": "541-247-0678",
"fax_number": "541-247-0317"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HALE",
"first_name": "JEAN",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-03",
"last_updated": "2010-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "OR",
"license": "1405",
"primary": true
},
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "OR",
"license": "1405",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "1405",
"primary": false
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "OR",
"license": "1405",
"primary": false
},
{
"code": "103TP2701X",
"taxonomy_group": "",
"desc": "Psychologist, Group Psychotherapy",
"state": "OR",
"license": "1405",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "262371",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gold Beach, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.