Provider Demographics
NPI:1407360951
Name:HANCOCK, LACEY ANN (LCMHC)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:ANN
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 E FORT UNION BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-5531
Mailing Address - Country:US
Mailing Address - Phone:801-984-1717
Mailing Address - Fax:801-984-1720
Practice Address - Street 1:613 E FORT UNION BLVD STE 104
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047
Practice Address - Country:US
Practice Address - Phone:801-984-1717
Practice Address - Fax:801-984-1720
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-20
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8756352-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health