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General NPI Number Information
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NPI Number | 1780954776
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Entity Type | Individual
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Provider Name | CHARLES S HANCOCK M.ED, LPC, NCC
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Gender | Male
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Dates
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Enumeration Date | 01/06/2012
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Last Update Date | 04/15/2021
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Provider Practice Location Address
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Address Line | 503 REMINGTON ST STE 102
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City | FORT COLLINS
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State | CO
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Zip | 80524-3089
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Country | US
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Telephone | 970-556-4095
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Fax |
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Provider Business Mailing Address
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Address Line | 343 W DRAKE RD STE 200
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City | FORT COLLINS
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State | CO
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Zip | 80526-2880
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Country | US
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Telephone | 970-829-0478
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | NLC-12364
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-11179
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License Number State | CO
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