Provider Demographics
NPI:1033525803
Name:HISSCOCK, GREGORY (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:
Last Name:HISSCOCK
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-3511
Mailing Address - Country:US
Mailing Address - Phone:303-831-9344
Mailing Address - Fax:303-831-9347
Practice Address - Street 1:758 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-3511
Practice Address - Country:US
Practice Address - Phone:303-831-9344
Practice Address - Fax:303-831-9347
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0011625101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health