Provider Demographics
NPI:1043458805
Name:HOCKETT, MARY KATHLEEN (LCPC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KATHLEEN
Last Name:HOCKETT
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W ROOSEVELT RD
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5088
Mailing Address - Country:US
Mailing Address - Phone:630-462-8810
Mailing Address - Fax:630-462-8820
Practice Address - Street 1:600 W ROOSEVELT RD
Practice Address - Street 2:SUITE A-2
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5088
Practice Address - Country:US
Practice Address - Phone:630-462-8810
Practice Address - Fax:630-462-8820
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-31
Last Update Date:2009-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-006320101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional