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General NPI Number Information
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NPI Number | 1427196526
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Entity Type | Individual
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Provider Name | CHARLES HANCOCK LPC, CAMFT,LCPC
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Gender | Male
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 06/26/2015
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Provider Practice Location Address
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Address Line | 1120 MONTANA ST
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City | GOODING
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State | ID
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Zip | 83330-1858
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Country | US
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Telephone | 208-934-4444
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Fax |
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Provider Business Mailing Address
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Address Line | 1120 MONTANA ST
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City | GOODING
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State | ID
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Zip | 83330-1858
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Country | US
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Telephone | 208-934-4444
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 7852
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 45016
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5846
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License Number State | ID
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