Provider Demographics
NPI:1255637567
Name:HOCKENBURY, JARROD TODD (MS LSAC)
Entity type:Individual
Prefix:MR
First Name:JARROD
Middle Name:TODD
Last Name:HOCKENBURY
Suffix:
Gender:M
Credentials:MS LSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 N 2900 E
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-6415
Mailing Address - Country:US
Mailing Address - Phone:435-229-1156
Mailing Address - Fax:
Practice Address - Street 1:179 N 2900 E
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-6415
Practice Address - Country:US
Practice Address - Phone:435-229-1156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7228748-6006101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT7228748-6006OtherSTATE LICENSE SUBSTANCE ABUSE COUNSELOR