Healthcare Provider Details

I. General information

NPI: 1801316468
Provider Name (Legal Business Name): JUSTIN DANIEL HAAKE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 06/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 CALHOUN ST STE 200
CINCINNATI OH
45219-1528
US

IV. Provider business mailing address

MAIL LOCATION 0039
CINCINNATI OH
45221-0039
US

V. Phone/Fax

Practice location:
  • Phone: 513-556-0648
  • Fax: 513-556-2302
Mailing address:
  • Phone: 513-556-0648
  • Fax: 513-556-2302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.1700355
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: