| Doctor Name: | DR. DOUGLAS LEE HAZEN |
| NPI Number: | 1205807823 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | |
| Business Practice Address: | 3420 Illinois St Reu - Uss Tranquillity Great Lakes, IL - 600883120 |
| Business Phone Number: | 8476887406 |
| Business Fax Number: | 8476887403 |
| Mailing Address: | 3420 Illinois St, Reu - Uss Tranquillity GREAT LAKES |
| State: | IL |
| Postal Code: | 600883120 |
| Phone Number: | 8476887406 |
| Fax Number: | 8476887403 |
| NPI Enumeration Date: | 01/31/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |