Individual
MRS. MARY SHANNON HAZEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
5021 RED HILL RD, NEWALLA, OK 74857-8834
(405) 391-7777
Mailing address
5021 RED HILL RD, NEWALLA, OK 74857-8834
(405) 391-7777
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
21587
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1881775211
—
OK
01
—
21587
OSBLSW
OK
Enumeration date
04/19/2022
Last updated
08/19/2025
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