Individual
JERRY WAYNE HACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW, LMFT
Contact information
Practice address
898 E MAIN ST, GREENWOOD, IN 46143-1407
(317) 887-1348
(317) 882-1631
Mailing address
198 STONEYBROOK DR, GREENWOOD, IN 46142-2108
(317) 887-1348
(317) 882-1631
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
34002364A
IN
106H00000X
Marriage & Family Therapist
Primary
35000040A
IN
Other
Enumeration date
03/16/2007
Last updated
01/24/2008
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