Basic Information
| Provider Information | |||||||||
| NPI: | 1497309074 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALE | ||||||||
| FirstName: | BRITTANY | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2328 WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | CONWAY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720322763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016790232 | ||||||||
| FaxNumber: | 8333730348 | ||||||||
| Practice Location | |||||||||
| Address1: | 2328 WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | CONWAY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720322763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016790232 | ||||||||
| FaxNumber: | 8333730348 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2019 | ||||||||
| LastUpdateDate: | 06/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | N | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst | 106S00000X | N | 103K00000X | 1-19-36753 | AR | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.