| Doctor Name: | MR. CHARLES HANCOCK |
| NPI Number: | 1427196526 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC, CAMFT,LCPC |
| License Number: | 7852 |
| Business Practice Address: | 1120 Montana St Gooding, ID - 833301858 |
| Business Phone Number: | 2089344444 |
| Business Fax Number: | |
| Mailing Address: | 1120 Montana St, GOODING |
| State: | ID |
| Postal Code: | 833301858 |
| Phone Number: | 2089344444 |
| Fax Number: | |
| NPI Enumeration Date: | 02/01/2007 |
| NPI Last Update Date: | 06/26/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 7852 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |