Provider Demographics
NPI:1639449481
Name:THACKER, JOHN DAKOTA (MRC, LPCC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DAKOTA
Last Name:THACKER
Suffix:
Gender:M
Credentials:MRC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 DARBY CREEK RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1604
Mailing Address - Country:US
Mailing Address - Phone:859-338-0466
Mailing Address - Fax:859-294-0802
Practice Address - Street 1:105 DIAGNOSTIC DR
Practice Address - Street 2:SUITE B
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-6559
Practice Address - Country:US
Practice Address - Phone:502-352-2208
Practice Address - Fax:502-352-2209
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLPCPCC00195375101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional