Provider Demographics
NPI:1063744274
Name:HANCOCK, PAMELA C (LPC, ATR)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:C
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:LPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1377
Mailing Address - Street 2:
Mailing Address - City:TELLURIDE
Mailing Address - State:CO
Mailing Address - Zip Code:81435-1377
Mailing Address - Country:US
Mailing Address - Phone:970-728-4989
Mailing Address - Fax:970-728-4989
Practice Address - Street 1:136 S. TOMBOY ST. #107
Practice Address - Street 2:PAMELA C HANCOCK
Practice Address - City:TELLURIDE
Practice Address - State:CO
Practice Address - Zip Code:81435
Practice Address - Country:US
Practice Address - Phone:970-728-4989
Practice Address - Fax:970-728-4989
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4759101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health