Individual
MS. HAZEL MAE SOUTHERLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
212 W EVERGREEN ST, DURANT, OK 74701-4710
(580) 931-9901
(580) 931-9953
Mailing address
212 W EVERGREEN ST, DURANT, OK 74701-4710
(580) 931-9901
(580) 931-9953
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3106
OK
Other
Enumeration date
07/12/2010
Last updated
07/12/2010
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