MEDICARE: DR. CHARLES HAZLEHURST PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	1291	CO

General Provider Information

NPI Number	:	1437192671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES HAZLEHURST PHD

Provider Business Mailing Address
First Line	:	8565 SOUTH POPLAR WAY
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80130
Country	:	US
Telephone Number	:	720-348-2800
Fax Number	:	720-345-8280

Provider Business Practice Location Address
First Line	:	8565 SOUTH POPLAR WAY
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80130
Country	:	US
Telephone Number	:	720-348-2800
Fax Number	:	720-348-2803

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	04/28/2010

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