Provider Demographics
NPI:1144676537
Name:HALES, DOUGLAS (LMFT)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:
Last Name:HALES
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 CULVER BLVD STE P
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-7776
Mailing Address - Country:US
Mailing Address - Phone:323-420-4653
Mailing Address - Fax:
Practice Address - Street 1:211 CULVER BLVD STE P
Practice Address - Street 2:
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-7776
Practice Address - Country:US
Practice Address - Phone:323-420-4653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27832101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health