Provider Demographics
NPI:1689041964
Name:JOHN JACK HUPERT, LMFT, PLLC
Entity Type:Organization
Organization Name:JOHN JACK HUPERT, LMFT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:HUPERT
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:305-877-0033
Mailing Address - Street 1:4030 POINCIANA AVE
Mailing Address - Street 2:
Mailing Address - City:COCONUT GROVE
Mailing Address - State:FL
Mailing Address - Zip Code:33133-6329
Mailing Address - Country:US
Mailing Address - Phone:305-877-0033
Mailing Address - Fax:
Practice Address - Street 1:4030 POINCIANA AVE
Practice Address - Street 2:
Practice Address - City:COCONUT GROVE
Practice Address - State:FL
Practice Address - Zip Code:33133-6329
Practice Address - Country:US
Practice Address - Phone:305-877-0033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT0599106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ3325AOtherMEDICARE