Provider Demographics
NPI:1679582902
Name:MCRAE, HAZEL LEIGH (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:HAZEL
Middle Name:LEIGH
Last Name:MCRAE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 CACTUS VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-2614
Mailing Address - Country:US
Mailing Address - Phone:512-865-1320
Mailing Address - Fax:
Practice Address - Street 1:101 W COOPERATIVE WAY STE 238
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-8208
Practice Address - Country:US
Practice Address - Phone:512-865-1320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12963101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113045203Medicaid