Provider Demographics
NPI:1366072167
Name:HAZEN'S MENTAL HEALTH
Entity type:Organization
Organization Name:HAZEN'S MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHEA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HAZEN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:575-497-9037
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:ELEPHANT BUTTE
Mailing Address - State:NM
Mailing Address - Zip Code:87935-0388
Mailing Address - Country:US
Mailing Address - Phone:575-497-9037
Mailing Address - Fax:
Practice Address - Street 1:1400 N SILVER ST
Practice Address - Street 2:
Practice Address - City:T OR C
Practice Address - State:NM
Practice Address - Zip Code:87901-1957
Practice Address - Country:US
Practice Address - Phone:575-894-7855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty