Provider Demographics
NPI:1396734984
Name:HUPERT, JACK JOSEPH (MS, LMFT, CAP)
Entity type:Individual
Prefix:MR
First Name:JACK
Middle Name:JOSEPH
Last Name:HUPERT
Suffix:
Gender:M
Credentials:MS, LMFT, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15100 NW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-2642
Mailing Address - Country:US
Mailing Address - Phone:305-685-8201
Mailing Address - Fax:305-685-0158
Practice Address - Street 1:15100 NW 27TH AVE
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-2642
Practice Address - Country:US
Practice Address - Phone:305-685-8201
Practice Address - Fax:305-685-0158
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMTO599106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist