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NPI Code Detail

MEDICARE: DONNA JEAN HAZLITT LPCC

MEDICARE: DONNA JEAN HAZLITT LPCC
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1912998568
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONNA JEAN HAZLITT LPCC
Provider Business Mailing Address
First Line : PO BOX 8459
Second Line :
City : PORTLAND
State : OR
Zip : 97207-8459
Country : US
Telephone Number : 503-238-0769
Fax Number :
Provider Business Practice Location Address
First Line : 7525 SE LAKE RD
Second Line :
City : MILWAUKIE
State : OR
Zip : 97267-2115
Country : US
Telephone Number : 503-303-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2005
Last Update Date : 10/20/2014

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