Provider Demographics
NPI:1285963223
Name:HALE, LUTHER RYAN (LCSW)
Entity type:Individual
Prefix:MR
First Name:LUTHER
Middle Name:RYAN
Last Name:HALE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 W SOUTHSLOPE RD
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-8800
Mailing Address - Country:US
Mailing Address - Phone:208-407-8916
Mailing Address - Fax:
Practice Address - Street 1:2640 W SOUTHSLOPE RD
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-8800
Practice Address - Country:US
Practice Address - Phone:208-407-8916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-22
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW301221041C0700X
IDLCSW -301121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical