Individual
MORGANA HAZELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
120 HOSPITAL DR, SUITE 100, LEBANON, MO 65536-9238
(417) 820-3128
(417) 820-8616
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
2011039220
MO
103TC0700X
Clinical Psychologist
Primary
2014001357
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063784411
—
MO
Enumeration date
02/01/2012
Last updated
02/05/2016
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