Provider Demographics
NPI:1023558467
Name:HAKE, MICHELE VINET (PHD, LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:VINET
Last Name:HAKE
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8705 SHOAL CREEK BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-6802
Mailing Address - Country:US
Mailing Address - Phone:512-426-5929
Mailing Address - Fax:
Practice Address - Street 1:8705 SHOAL CREEK BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-6802
Practice Address - Country:US
Practice Address - Phone:512-426-5929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-05
Last Update Date:2017-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX252821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical