Provider Demographics
NPI:1053723965
Name:HACKER, CHAD (LMHC)
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:
Last Name:HACKER
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ARGOS
Mailing Address - State:IN
Mailing Address - Zip Code:46501-1258
Mailing Address - Country:US
Mailing Address - Phone:574-316-0201
Mailing Address - Fax:
Practice Address - Street 1:304 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-1768
Practice Address - Country:US
Practice Address - Phone:574-316-0201
Practice Address - Fax:574-316-0201
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IN39002784A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health