Provider Demographics
NPI:1366890014
Name:HATZEL, ALICIA COLEEN (RBT)
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:COLEEN
Last Name:HATZEL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 W LEVI WAY
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-5606
Mailing Address - Country:US
Mailing Address - Phone:541-297-7172
Mailing Address - Fax:
Practice Address - Street 1:218 W LEVI WAY
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-5606
Practice Address - Country:US
Practice Address - Phone:541-297-7172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OR106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101Y00000XBehavioral Health & Social Service ProvidersCounselor