Provider Demographics
NPI:1720234552
Name:COLVIN, HAZEL SUMMERS III (MA LPC)
Entity type:Individual
Prefix:MR
First Name:HAZEL
Middle Name:SUMMERS
Last Name:COLVIN
Suffix:III
Gender:M
Credentials:MA LPC
Other - Prefix:
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Mailing Address - Street 1:9901 IH 10 W
Mailing Address - Street 2:SUITE 800
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2292
Mailing Address - Country:US
Mailing Address - Phone:210-558-2849
Mailing Address - Fax:210-694-0892
Practice Address - Street 1:530 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5006
Practice Address - Country:US
Practice Address - Phone:210-558-8744
Practice Address - Fax:210-558-4276
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX8689101YP2500X
TXLPC#8689101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional