Provider Demographics
NPI:1952491367
Name:HAZEL, JOHN STEPHEN (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:STEPHEN
Last Name:HAZEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 COLLEGE BLVD.
Mailing Address - Street 2:SUITE 250
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1944
Mailing Address - Country:US
Mailing Address - Phone:913-451-8550
Mailing Address - Fax:913-469-5266
Practice Address - Street 1:7501 COLLEGE BLVD STE 250
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2505
Practice Address - Country:US
Practice Address - Phone:913-451-8550
Practice Address - Fax:913-469-5266
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0566103T00000X
MOR0450103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12362015OtherBCBS KC
KS100238030AMedicaid
KS100238030AMedicaid
R80789Medicare UPIN
MOC58216AMedicare ID - Type Unspecified