Provider Demographics
NPI:1083889158
Name:HASLAM, GEORGE DONALD SR
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:DONALD
Last Name:HASLAM
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DON
Other - Middle Name:
Other - Last Name:HASLAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1030
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-1030
Mailing Address - Country:US
Mailing Address - Phone:580-298-2830
Mailing Address - Fax:
Practice Address - Street 1:411 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-6059
Practice Address - Country:US
Practice Address - Phone:580-286-5045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health