Provider Demographics
NPI:1932723863
Name:HAZEL, CHLOE OLIVIA (LPC INTERN)
Entity Type:Individual
Prefix:MRS
First Name:CHLOE
Middle Name:OLIVIA
Last Name:HAZEL
Suffix:
Gender:F
Credentials:LPC INTERN
Other - Prefix:MISS
Other - First Name:CHLOE
Other - Middle Name:OLIVIA
Other - Last Name:HALLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:296 SW COLUMBIA ST
Mailing Address - Street 2:STE. D2
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:296 SW COLUMBIA ST
Practice Address - Street 2:STE. D2
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702
Practice Address - Country:US
Practice Address - Phone:541-550-7940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-06
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health