Provider Demographics
NPI:1477872471
Name:GARY LEE HITCHCOCK, PH.D.
Entity Type:Organization
Organization Name:GARY LEE HITCHCOCK, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HITCHCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:805-458-6881
Mailing Address - Street 1:3448 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6020
Mailing Address - Country:US
Mailing Address - Phone:805-458-6881
Mailing Address - Fax:805-543-3241
Practice Address - Street 1:3448 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-6020
Practice Address - Country:US
Practice Address - Phone:805-458-6881
Practice Address - Fax:805-543-3241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18045251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management