Provider Demographics
NPI:1609100544
Name:HAZLEWOOD, KIMBERLY COLE (PPS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:COLE
Last Name:HAZLEWOOD
Suffix:
Gender:F
Credentials:PPS
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 1213
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93062-1213
Mailing Address - Country:US
Mailing Address - Phone:805-390-5586
Mailing Address - Fax:
Practice Address - Street 1:232 E CANON PERDIDO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2242
Practice Address - Country:US
Practice Address - Phone:805-963-1433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)