=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366529711
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTOPHER J HASSELTINE MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5303 TRINITY BLVD SUITE A
-----------------------------------------------------
City | SNYDER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79549-6165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-573-3757
-----------------------------------------------------
Fax | 325-573-3917
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5303 TRINITY BLVD SUITE A
-----------------------------------------------------
City | SNYDER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79549-6165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-573-3757
-----------------------------------------------------
Fax | 325-573-3917
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRIST
-----------------------------------------------------
Name | DR. CHRISTOPHER J HASSELTINE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 325-573-0041
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | K2034
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------