Provider Demographics
NPI:1093570145
Name:HAZEL TREE WELLNESS, LLC
Entity Type:Organization
Organization Name:HAZEL TREE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DESMOND
Authorized Official - Middle Name:JASPER
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:301-202-4495
Mailing Address - Street 1:75 S MAIN ST
Mailing Address - Street 2:PMB 335
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-4868
Mailing Address - Country:US
Mailing Address - Phone:301-202-4495
Mailing Address - Fax:
Practice Address - Street 1:75 S MAIN ST
Practice Address - Street 2:PMB 335
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4868
Practice Address - Country:US
Practice Address - Phone:301-202-4495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty