Provider Demographics
NPI:1780231233
Name:HAZEL, NICOLE RENEE (BSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:RENEE
Last Name:HAZEL
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5896 CROSSCUT LN
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-9672
Mailing Address - Country:US
Mailing Address - Phone:317-200-0046
Mailing Address - Fax:
Practice Address - Street 1:5896 CROSSCUT LN
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-9672
Practice Address - Country:US
Practice Address - Phone:317-200-0046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist