Provider Demographics
NPI:1376714584
Name:HAMMOCK, JOSEPH C JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:C
Last Name:HAMMOCK
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 INTERNATIONAL CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3161
Mailing Address - Country:US
Mailing Address - Phone:719-460-9055
Mailing Address - Fax:719-387-4645
Practice Address - Street 1:3225 INTERNATIONAL CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3161
Practice Address - Country:US
Practice Address - Phone:719-460-9055
Practice Address - Fax:719-387-4645
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO891103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07008915Medicaid
CO07008915Medicaid