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General NPI Number Information
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NPI Number | 1053723965
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Entity Type | Individual
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Provider Name | CHAD HACKER LMHC
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Gender | Male
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Dates
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Enumeration Date | 05/27/2014
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 304 N WALNUT ST
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City | PLYMOUTH
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State | IN
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Zip | 46563-1768
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Country | US
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Telephone | 574-316-0201
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Fax | 574-316-0201
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Provider Business Mailing Address
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Address Line | 314 E WALNUT ST
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City | ARGOS
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State | IN
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Zip | 46501-1258
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Country | US
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Telephone | 574-316-0201
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 39002784A
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License Number State | IN
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