Provider Demographics
NPI:1538255245
Name:HAZLEWOOD-HUNT, LISA ANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANNE
Last Name:HAZLEWOOD-HUNT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 78 BOX 1511
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96326-0016
Mailing Address - Country:US
Mailing Address - Phone:804-073-4518
Mailing Address - Fax:
Practice Address - Street 1:374 MDG
Practice Address - Street 2:UNIT 5071
Practice Address - City:APO
Practice Address - State:CA
Practice Address - Zip Code:96326
Practice Address - Country:US
Practice Address - Phone:760-809-3801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12052103T00000X
CA12052103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist