Provider Demographics
NPI:1710540992
Name:HANKS, JACOB (LPC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:HANKS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SILT
Mailing Address - State:CO
Mailing Address - Zip Code:81652-9316
Mailing Address - Country:US
Mailing Address - Phone:970-260-0868
Mailing Address - Fax:
Practice Address - Street 1:1319 GRAND AVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3842
Practice Address - Country:US
Practice Address - Phone:970-260-0868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0015217101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health