Provider Demographics
NPI:1215457684
Name:HUNSAKER, JACOB CHRISTIAN (LMFT)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:CHRISTIAN
Last Name:HUNSAKER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 THRUSHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4825
Mailing Address - Country:US
Mailing Address - Phone:435-538-2152
Mailing Address - Fax:
Practice Address - Street 1:975 THRUSHWOOD DR
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-4825
Practice Address - Country:US
Practice Address - Phone:435-538-2152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9424876-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT9424876-3902OtherSTATE OF UTAH DEPARTMENT OF COMMERCE, DOPL