Provider Demographics
NPI:1306992938
Name:HAZEL MACKEY CENTER
Entity type:Organization
Organization Name:HAZEL MACKEY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FISCAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BARNEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRUZETTI
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:217-544-0388
Mailing Address - Street 1:1128 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-2314
Mailing Address - Country:US
Mailing Address - Phone:217-544-0388
Mailing Address - Fax:217-544-0391
Practice Address - Street 1:1128 S 5TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-2314
Practice Address - Country:US
Practice Address - Phone:217-544-0388
Practice Address - Fax:217-544-0391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-00384101YP2500X
IL101YP2500X, 1041C0700X, 1041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty