Basic Information
| Provider Information | |||||||||
| NPI: | 1710484365 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAWBAKER | ||||||||
| FirstName: | JACOB | ||||||||
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| Credential: | LAMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12610 N GRANVILLE CANYON WAY | ||||||||
| Address2: | |||||||||
| City: | ORO VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857558937 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3295 W INA RD STE 125 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857412195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202571168 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2018 | ||||||||
| LastUpdateDate: | 04/10/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | LAMFT-10591 | AZ | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.