Provider Demographics
NPI:1932670981
Name:HUCK, JACOB PRESTON (MED, LPCC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:PRESTON
Last Name:HUCK
Suffix:
Gender:M
Credentials:MED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 WOLF LEDGES PKWY
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44311-1028
Mailing Address - Country:US
Mailing Address - Phone:330-379-0667
Mailing Address - Fax:234-571-0107
Practice Address - Street 1:411 WOLF LEDGES PKWY
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-1028
Practice Address - Country:US
Practice Address - Phone:330-379-0667
Practice Address - Fax:234-571-0107
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2303642101YP2500X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist