Kyle Max Hancock, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

74537142501 Issued in UT

Practice address

246 E 1260 N
Logan, UT 84341-7501

Phone

(435) 750-6300

Fax

(435) 753-8995

NPI assigned

Apr 7, 2010

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mount Logan Clinic LLC

  • Mental Health Counselor
  • Logan, UT
  • NPI 1275152910
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1270598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1270598400000",
    "number": "1164748729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "246 E 1260 N",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843417501",
            "telephone_number": "435-750-6300",
            "fax_number": "435-753-8995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "246 E 1260 N",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843417501",
            "telephone_number": "435-750-6300",
            "fax_number": "435-753-8995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANCOCK",
        "first_name": "KYLE",
        "middle_name": "MAX",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-04-07",
        "last_updated": "2010-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "UT",
            "license": "74537142501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rodney L Hammer
• Keith Daines Hammond, D.D.S.
• Angelee Hancey
• Sophie Victoria Hancey
• Ian Hancock
• Joseph Michael Hannan, LMFT, MS
• Tyler Ross Hanny, DO
• Emily Ann Hanover
• Amber Nichole Hansen
• Cassidy Hansen

• Psychologist in Logan, UT
• Providers in Logan, UT by specialty
• Psychologist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.