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General NPI Number Information
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NPI Number | 1093570145
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Entity Type | Organization
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Legal Business Name | HAZEL TREE WELLNESS, LLC
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Dates
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Enumeration Date | 02/19/2024
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Last Update Date | 02/28/2024
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Provider Practice Location Address
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Address Line | 75 S MAIN ST PMB 335
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City | CONCORD
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State | NH
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Zip | 03301-4868
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Country | US
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Telephone | 301-202-4495
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Fax |
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Provider Business Mailing Address
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Address Line | 75 S MAIN ST PMB 335
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City | CONCORD
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State | NH
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Zip | 03301-4868
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Country | US
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Telephone | 301-202-4495
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICIAN
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Name | DESMOND JASPER STERN
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Credential | LCMHC
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Telephone | 301-202-4495
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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