Healthcare Provider Details

I. General information

NPI: 1053895367
Provider Name (Legal Business Name): HAZEL TREE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 CLAYTON ST
ASHEVILLE NC
28801-2424
US

IV. Provider business mailing address

84 MIDDLEMONT AVE
ASHEVILLE NC
28806-2557
US

V. Phone/Fax

Practice location:
  • Phone: 828-907-1392
  • Fax:
Mailing address:
  • Phone: 954-243-9970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. MARTINE LUNTZ JONES
Title or Position: LICENSED PSYCHOLOGIST
Credential: PSY.D.
Phone: 954-243-9970