Provider Demographics
NPI:1316329196
Name:HANCOCK-MUCK, LORI (LMHC, CADC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:HANCOCK-MUCK
Suffix:
Gender:F
Credentials:LMHC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 4TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-1597
Mailing Address - Country:US
Mailing Address - Phone:515-471-2317
Mailing Address - Fax:
Practice Address - Street 1:505 5TH AVE
Practice Address - Street 2:STE.600
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-2324
Practice Address - Country:US
Practice Address - Phone:515-471-2317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01102101YA0400X
IA00825101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)