Provider Demographics
NPI:1942670377
Name:HAZEL, CHRIS (LPC)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:HAZEL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1707
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-1707
Mailing Address - Country:US
Mailing Address - Phone:208-947-3382
Mailing Address - Fax:
Practice Address - Street 1:136 E SAN ANTONIO ST # 103
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-5509
Practice Address - Country:US
Practice Address - Phone:512-620-1401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78045101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3789273Medicaid