=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194926006
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOSEPH C HAMMOCK PHD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2007
-----------------------------------------------------
Last Update Date | 12/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3630 SINTON RD STE 100
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80907-5072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-460-9055
-----------------------------------------------------
Fax | 719-387-4645
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3630 SINTON RD STE 100
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80907-5072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-460-9055
-----------------------------------------------------
Fax | 719-387-4645
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JOSEPH C HAMMOCK JR.
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 719-460-9055
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 891
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------