Provider Demographics
NPI:1710326251
Name:HAACKE, AUSTIN C (AMFT)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:C
Last Name:HAACKE
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 S CARTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-7239
Mailing Address - Country:US
Mailing Address - Phone:801-592-2423
Mailing Address - Fax:
Practice Address - Street 1:1406 S CARTERVILLE RD
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-7239
Practice Address - Country:US
Practice Address - Phone:801-592-2423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1201-21695106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist