Provider Demographics
NPI:1932449667
Name:HACKING, JUSTIN JACOBS (LPC)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:JACOBS
Last Name:HACKING
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 1:1011 W WILLIAMS ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-3564
Mailing Address - Country:US
Mailing Address - Phone:208-991-0770
Mailing Address - Fax:
Practice Address - Street 1:1011 W WILLIAMS ST
Practice Address - Street 2:SUITE G
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-3564
Practice Address - Country:US
Practice Address - Phone:208-991-0077
Practice Address - Fax:208-922-3778
Is Sole Proprietor?:No
Enumeration Date:2013-02-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health