1932723863 NPI number — MRS. CHLOE OLIVIA HAZEL LPC INTERN

Table of content: MRS. CHLOE OLIVIA HAZEL LPC INTERN (NPI 1932723863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932723863 NPI number — MRS. CHLOE OLIVIA HAZEL LPC INTERN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAZEL
Provider First Name:
CHLOE
Provider Middle Name:
OLIVIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC INTERN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HALLOCK
Provider Other First Name:
CHLOE
Provider Other Middle Name:
OLIVIA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932723863
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
296 SW COLUMBIA ST
Provider Second Line Business Mailing Address:
STE. D2
Provider Business Mailing Address City Name:
BEND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
296 SW COLUMBIA ST
Provider Second Line Business Practice Location Address:
STE. D2
Provider Business Practice Location Address City Name:
BEND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-550-7940
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/06/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  C7398 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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