Provider Demographics
NPI:1205900644
Name:CRYSTAL K. HAZELWOOD & ASSOCIATES P.A.
Entity type:Organization
Organization Name:CRYSTAL K. HAZELWOOD & ASSOCIATES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:K
Authorized Official - Last Name:HAZELWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC MAC
Authorized Official - Phone:904-269-4783
Mailing Address - Street 1:56 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5965
Mailing Address - Country:US
Mailing Address - Phone:904-269-4783
Mailing Address - Fax:904-269-2949
Practice Address - Street 1:1950 MILLER ST
Practice Address - Street 2:SUITE 6
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4759
Practice Address - Country:US
Practice Address - Phone:904-269-5356
Practice Address - Fax:904-269-2088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP1893L101YA0400X
FLMH4540101YM0800X
FL614406101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty