Provider Demographics
NPI:1407164817
Name:HAZELWOOD, TERRI (LMSW, LCAC)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:HAZELWOOD
Suffix:
Gender:F
Credentials:LMSW, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 CLINTON PKWY
Mailing Address - Street 2:A201
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-2220
Mailing Address - Country:US
Mailing Address - Phone:785-766-0641
Mailing Address - Fax:
Practice Address - Street 1:4105 W 6TH ST
Practice Address - Street 2:SUITE B2
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4609
Practice Address - Country:US
Practice Address - Phone:785-766-0641
Practice Address - Fax:785-841-0026
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4327104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker