Provider Demographics
NPI:1184172777
Name:HAZEN, RAY EDWARD (MA)
Entity type:Individual
Prefix:
First Name:RAY
Middle Name:EDWARD
Last Name:HAZEN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 COTTONWOOD BLVD UNIT 19
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-2661
Mailing Address - Country:US
Mailing Address - Phone:719-351-8940
Mailing Address - Fax:
Practice Address - Street 1:701 S 27TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-4511
Practice Address - Country:US
Practice Address - Phone:406-247-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2017-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7046101YA0400X
CO5529101YP2500X
ORC4355101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)