Provider Demographics
NPI:1023684750
Name:HALE, COURTLYN RAYE (MED, LPC)
Entity type:Individual
Prefix:
First Name:COURTLYN
Middle Name:RAYE
Last Name:HALE
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 STERRITT RD
Mailing Address - Street 2:
Mailing Address - City:WINNIE
Mailing Address - State:TX
Mailing Address - Zip Code:77665-7348
Mailing Address - Country:US
Mailing Address - Phone:409-550-4632
Mailing Address - Fax:
Practice Address - Street 1:3380 FANNIN ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-3840
Practice Address - Country:US
Practice Address - Phone:409-832-6223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83067101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional