Provider Demographics
NPI:1619473386
Name:HAMMACK, KERRY DUANE (LPC)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:DUANE
Last Name:HAMMACK
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2277 N MOUNTAIN ESTATES RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:CO
Mailing Address - Zip Code:80816-8957
Mailing Address - Country:US
Mailing Address - Phone:719-208-7700
Mailing Address - Fax:
Practice Address - Street 1:2277 N MOUNTAIN ESTATES RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:CO
Practice Address - Zip Code:80816-8957
Practice Address - Country:US
Practice Address - Phone:719-208-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0011746101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0011746OtherLICENSED PROFESSIONAL COUNSELOR