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
StateLicense IDTaxonomies
UT036948935011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty