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General NPI Number Information
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NPI Number | 1285418004
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Entity Type | Organization
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Legal Business Name | HAZEL'S HOPE & INTEGRATED HEALTH
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Dates
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Enumeration Date | 08/22/2023
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 2330 N 75TH AVE STE 105
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City | PHOENIX
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State | AZ
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Zip | 85035-1200
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Country | US
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Telephone | 623-289-7306
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Fax |
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Provider Business Mailing Address
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Address Line | 2330 N 75TH AVE STE 105
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City | PHOENIX
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State | AZ
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Zip | 85035-1200
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JACHEL GRAY
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Credential |
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Telephone | 480-410-8944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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