Healthcare Provider Details

I. General information

NPI: 1942365671
Provider Name (Legal Business Name): JOHN E HANCOCK EDD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 17TH ST
GREELEY CO
80631-5126
US

IV. Provider business mailing address

2120 17TH ST
GREELEY CO
80631-5126
US

V. Phone/Fax

Practice location:
  • Phone: 503-593-3693
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY.0005859
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: