1396734984 NPI number — MR. JACK JOSEPH HUPERT MS, LMFT, CAP

Table of content: MR. JACK JOSEPH HUPERT MS, LMFT, CAP (NPI 1396734984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396734984 NPI number — MR. JACK JOSEPH HUPERT MS, LMFT, CAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUPERT
Provider First Name:
JACK
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MS, LMFT, CAP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396734984
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15100 NW 27TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OPA LOCKA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33054-2642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-685-8201
Provider Business Mailing Address Fax Number:
305-685-0158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15100 NW 27TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OPA LOCKA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33054-2642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-685-8201
Provider Business Practice Location Address Fax Number:
305-685-0158
Provider Enumeration Date:
10/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MTO599 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com