Organization
LIFESPAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HAZEL SOUTHERLAND LPC (EXECUTIVE DIRECTOR)
(580) 931-9901
Entity
Organization
Contact information
Practice address
212 W EVERGREEN ST, DURANT, OK 74701-4710
(580) 931-9901
Mailing address
212 W EVERGREEN ST, DURANT, OK 74701-4710
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
OK
Other
Enumeration date
04/04/2013
Last updated
04/04/2013
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