MEDICARE: JENNY LYN HAZLETT LPC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor		CO
2	101Y00000X	Counselor	LPC.0018069	CO

General Provider Information

NPI Number	:	1770089740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY LYN HAZLETT LPC

Provider Business Mailing Address
First Line	:	109 W BEAVER AVE
Second Line	:
City	:	FORT MORGAN
State	:	CO
Zip	:	80701-2123
Country	:	US
Telephone Number	:	970-616-0723
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 W BEAVER AVE
Second Line	:
City	:	FORT MORGAN
State	:	CO
Zip	:	80701-2123
Country	:	US
Telephone Number	:	970-616-0723
Fax Number	:

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

Provider Enumeration Date	:	03/30/2018
Last Update Date	:	05/11/2024

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