Healthcare Provider Details

I. General information

NPI: 1538255245
Provider Name (Legal Business Name): LISA ANNE HAZLEWOOD-HUNT PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 MDG UNIT 5071
APO CA
96326
US

IV. Provider business mailing address

PSC 78 BOX 1511
APO AP
96326-0016
US

V. Phone/Fax

Practice location:
  • Phone: 760-809-3801
  • Fax:
Mailing address:
  • Phone: 804-073-4518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY12052
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number12052
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: