Provider Demographics
NPI:1033267117
Name:HACKETT, IRIS ELIZABETH (LPC)
Entity Type:Individual
Prefix:MISS
First Name:IRIS
Middle Name:ELIZABETH
Last Name:HACKETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N I H 35
Mailing Address - Street 2:315 PMB 182
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-5003
Mailing Address - Country:US
Mailing Address - Phone:512-587-7440
Mailing Address - Fax:512-218-4150
Practice Address - Street 1:110 N. IH 35
Practice Address - Street 2:315 PMB 182
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681
Practice Address - Country:US
Practice Address - Phone:512-587-7440
Practice Address - Fax:512-218-4150
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16566101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137954OtherSUPERIOR
TX542851OtherVALUE OPTIONS