Provider Demographics
NPI:1144596115
Name:JCMH - HAZEL CENTER
Entity Type:Organization
Organization Name:JCMH - HAZEL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:A
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:541-737-3952
Mailing Address - Street 1:1911 HAZEL AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-1630
Mailing Address - Country:US
Mailing Address - Phone:541-734-3950
Mailing Address - Fax:541-734-3960
Practice Address - Street 1:1911 HAZEL AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-1630
Practice Address - Country:US
Practice Address - Phone:541-734-3950
Practice Address - Fax:541-734-3960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR514136251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management