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Provider Information for 1851710222


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Mr. NEIL TRAVIS HETZEL MS, LPC


Sex: Male

NPI: 1851710222
Last Updated: 2021-05-24
Certification Date: 2021-05-24

Details

NameValue
NPI1851710222
Enumeration Date2014-04-14
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 18843 W LAUREL LN
SURPRISE, AZ 85388-3258
United States

Phone: 623-466-3482 | Fax:480-963-2036
 
Primary Practice Address 18843 W LAUREL LN
SURPRISE, AZ 85388-3258
United States

Phone: 623-466-3482 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YM0800X - Counselor - Mental HealthAZLPC-17620
No 101YM0800X - Counselor - Mental HealthAZLAC-14358