| Doctor Name: | HAZEL BERRY |
| NPI Number: | 1184017444 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | C3692/ACTIVE |
| Business Practice Address: | 412 Alder St Brookings, OR - 974159014 |
| Business Phone Number: | 5418132535 |
| Business Fax Number: | 5418132536 |
| Mailing Address: | 94235 Moore St Ste 121, GOLD BEACH |
| State: | OR |
| Postal Code: | 974449704 |
| Phone Number: | 5418132535 |
| Fax Number: | 5418132536 |
| NPI Enumeration Date: | 03/11/2015 |
| NPI Last Update Date: | 03/11/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | C3692/ACTIVE |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |