Most Relevant Information
Provider Data
| NPI Number: | 1003331182 |
| Provider Name: | SAMANTHA BLAIR HALE M.ED, PCMHT |
| Entity Type: | Individual |
| Taxonomy Code: | 261QM0801X |
| Specialty: | Clinic/Center |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/09/2017 |
| Last Updated: | 07/21/2019 |
Provider Practice Location
604 HIGHWAY 80 W STE R
CLINTON
MS
39056
Practice Location Phone/Fax
| Phone: | 6014732106 |
| Fax: | 6014732150 |
Provider Mailing Location
PO BOX 701
CLINTON
MS
390600701
Provider Mailing Phone/Fax
| Phone: | 6014732106 |
| Fax: | 6014732150 |