Provider Demographics
NPI:1245670256
Name:HAZEL, ASHLEY (PHD, BCBA-D)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:HAZEL
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:LANGELIERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA-D
Mailing Address - Street 1:2730 SHADELANDS DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2538
Mailing Address - Country:US
Mailing Address - Phone:661-477-0911
Mailing Address - Fax:
Practice Address - Street 1:2730 SHADELANDS DR
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2538
Practice Address - Country:US
Practice Address - Phone:661-477-0911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33575103TC0700X
CA11314005103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical