Provider Demographics
NPI:1497197982
Name:HANCOCK, HOLLIE (EDD)
Entity Type:Individual
Prefix:DR
First Name:HOLLIE
Middle Name:
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9425 S UNION SQ
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3402
Mailing Address - Country:US
Mailing Address - Phone:385-242-3529
Mailing Address - Fax:
Practice Address - Street 1:9425 S UNION SQ
Practice Address - Street 2:SUITE 5
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-3402
Practice Address - Country:US
Practice Address - Phone:385-242-3529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7522957-6004101Y00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling