Provider Demographics
NPI:1346406873
Name:HAZELETT, CHRISTINE (LCPC ATR-BC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:HAZELETT
Suffix:
Gender:F
Credentials:LCPC ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 SHERMAN AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4361
Mailing Address - Country:US
Mailing Address - Phone:847-254-4550
Mailing Address - Fax:
Practice Address - Street 1:1316 SHERMAN AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4361
Practice Address - Country:US
Practice Address - Phone:847-254-4550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004922101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional