Provider Demographics
NPI:1922156629
Name:HAZZARD, JILL A (LMHC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:HAZZARD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6541 MYAKKA VALLEY TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34241-9671
Mailing Address - Country:US
Mailing Address - Phone:941-504-0770
Mailing Address - Fax:
Practice Address - Street 1:7269 BEE RIDGE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34241-5969
Practice Address - Country:US
Practice Address - Phone:941-504-0770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4908101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health