Active NPI
Jerry Wayne Hack, LCSW, LMFT
- Marriage & Family Therapist
- Greenwood, IN
National Provider Identifier
1770607863
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 35000040A
- Practice address
- 898 E Main St
Greenwood, IN 46143-1407 - Phone
- (317) 887-1348
- Fax
- (317) 882-1631
- NPI assigned
- Mar 16, 2007
- Last updated
- Jan 24, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 34002364A | IN | |
| Marriage & Family Therapist | 106H00000X | 35000040A | IN | Primary |
Addresses
Primary practice location
898 E Main St
Greenwood, IN 46143-1407
Mailing address
198 Stoneybrook Dr
Greenwood, IN 46142-2108
Phone (317) 887-1348
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34002364A | IN | MD | Clinical Social Worker |
| 35000040A | IN | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1201132800000",
"number": "1770607863",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "198 STONEYBROOK DR",
"city": "GREENWOOD",
"state": "IN",
"postal_code": "461422108",
"telephone_number": "317-887-1348",
"fax_number": "317-882-1631"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "898 E MAIN ST",
"city": "GREENWOOD",
"state": "IN",
"postal_code": "461431407",
"telephone_number": "317-887-1348",
"fax_number": "317-882-1631"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HACK",
"first_name": "JERRY",
"middle_name": "WAYNE",
"credential": "LCSW, LMFT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-16",
"last_updated": "2008-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IN",
"license": "34002364A",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "IN",
"license": "35000040A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenwood, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.