Provider Demographics
NPI:1588716039
Name:HALES, MARK T (LICSW)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:T
Last Name:HALES
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 S NUTMEG WAY
Mailing Address - Street 2:
Mailing Address - City:VINEYARD
Mailing Address - State:UT
Mailing Address - Zip Code:84059-8123
Mailing Address - Country:US
Mailing Address - Phone:385-333-2149
Mailing Address - Fax:
Practice Address - Street 1:276 E 950 S
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-7054
Practice Address - Country:US
Practice Address - Phone:385-333-2149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN171331041C0700X
IA064551041C0700X
ND38461041C0700X
SD20381041C0700X
UT362016-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical