Provider Demographics
NPI:1043508781
Name:HALE, TABETHA HEATHER (LPC)
Entity type:Individual
Prefix:
First Name:TABETHA
Middle Name:HEATHER
Last Name:HALE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TABETHA
Other - Middle Name:HEATHER
Other - Last Name:HERTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1310 VALLEY VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-6080
Mailing Address - Country:US
Mailing Address - Phone:814-944-9970
Mailing Address - Fax:814-944-9974
Practice Address - Street 1:1310 VALLEY VIEW BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-6080
Practice Address - Country:US
Practice Address - Phone:814-944-9970
Practice Address - Fax:814-944-9974
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006242101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102806734 0001Medicaid