Provider Demographics
NPI:1851710222
Name:HETZEL, NEIL TRAVIS (MS, LPC)
Entity Type:Individual
Prefix:MR
First Name:NEIL
Middle Name:TRAVIS
Last Name:HETZEL
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18843 W LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-3258
Mailing Address - Country:US
Mailing Address - Phone:623-466-3482
Mailing Address - Fax:480-963-2036
Practice Address - Street 1:18843 W LAUREL LN
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-3258
Practice Address - Country:US
Practice Address - Phone:623-466-3482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-17620101YM0800X
AZLAC-14358101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health