Provider Demographics
NPI:1861822603
Name:LEE, HAZEL AVELLANOSA
Entity Type:Individual
Prefix:
First Name:HAZEL
Middle Name:AVELLANOSA
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HAZEL
Other - Middle Name:AGUIRRE
Other - Last Name:AVELLANOSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, MFTI
Mailing Address - Street 1:10 DOUGLAS DR STE 140
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4078
Mailing Address - Country:US
Mailing Address - Phone:925-313-1158
Mailing Address - Fax:925-313-1142
Practice Address - Street 1:10 DOUGLAS DR STE 140
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4078
Practice Address - Country:US
Practice Address - Phone:925-313-1158
Practice Address - Fax:925-313-1142
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF74152106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist