Provider Demographics
NPI: | 1619109444 |
---|---|
Name: | C.HAKES,LLC |
Entity Type: | Organization |
Organization Name: | C.HAKES,LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MANAGING MAMBER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | CHRIS |
Authorized Official - Middle Name: | COREY |
Authorized Official - Last Name: | HAKES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LCSW |
Authorized Official - Phone: | 801-414-3252 |
Mailing Address - Street 1: | 50 N MAIN ST |
Mailing Address - Street 2: | |
Mailing Address - City: | TOOELE |
Mailing Address - State: | UT |
Mailing Address - Zip Code: | 84074-2139 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 801-414-3252 |
Mailing Address - Fax: | 801-733-4083 |
Practice Address - Street 1: | 50 N MAIN ST |
Practice Address - Street 2: | |
Practice Address - City: | TOOELE |
Practice Address - State: | UT |
Practice Address - Zip Code: | 84074-2139 |
Practice Address - Country: | US |
Practice Address - Phone: | 801-414-3252 |
Practice Address - Fax: | 801-733-4083 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-08-12 |
Last Update Date: | 2009-08-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
UT | 03694893501 | 1041C0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |