Provider Demographics
NPI:1881765477
Name:HAZLEWOOD, LONNIE RAY (MSHP)
Entity type:Individual
Prefix:MR
First Name:LONNIE
Middle Name:RAY
Last Name:HAZLEWOOD
Suffix:
Gender:M
Credentials:MSHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W 38TH ST
Mailing Address - Street 2:STE 424
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731
Mailing Address - Country:US
Mailing Address - Phone:512-323-0666
Mailing Address - Fax:512-323-0666
Practice Address - Street 1:1600 W 38TH ST
Practice Address - Street 2:STE 424
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731
Practice Address - Country:US
Practice Address - Phone:512-323-0666
Practice Address - Fax:512-323-0666
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7171101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health