Provider Demographics
NPI:1427196526
Name:HANCOCK, CHARLES (LPC, CAMFT,LCPC)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:HANCOCK
Suffix:
Gender:M
Credentials:LPC, CAMFT,LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 MONTANA ST
Mailing Address - Street 2:
Mailing Address - City:GOODING
Mailing Address - State:ID
Mailing Address - Zip Code:83330-1858
Mailing Address - Country:US
Mailing Address - Phone:208-934-4444
Mailing Address - Fax:
Practice Address - Street 1:1120 MONTANA ST
Practice Address - Street 2:
Practice Address - City:GOODING
Practice Address - State:ID
Practice Address - Zip Code:83330-1858
Practice Address - Country:US
Practice Address - Phone:208-934-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7852101YM0800X
CA45016106H00000X
ID5846101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist