Provider Demographics
NPI:1699004168
Name:HASEK, GREGORY ALAN (MA/MFT LPC, LMHC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:ALAN
Last Name:HASEK
Suffix:
Gender:M
Credentials:MA/MFT LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24840 BURNT PINE DR
Mailing Address - Street 2:SUITES 1 & 2
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-2999
Mailing Address - Country:US
Mailing Address - Phone:239-301-4464
Mailing Address - Fax:
Practice Address - Street 1:24840 BURNT PINE DR
Practice Address - Street 2:SUITES 1 & 2
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-2999
Practice Address - Country:US
Practice Address - Phone:239-301-4464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-13
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 13637101YP2500X, 101Y00000X, 106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist