Provider Demographics
NPI:1366859605
Name:HANSELMAN, SHAYLA (LPC)
Entity Type:Individual
Prefix:
First Name:SHAYLA
Middle Name:
Last Name:HANSELMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 N CHISHOLM TRAIL WAY
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-3644
Mailing Address - Country:US
Mailing Address - Phone:405-353-0203
Mailing Address - Fax:
Practice Address - Street 1:609 N CHISHOLM TRAIL WAY
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-3644
Practice Address - Country:US
Practice Address - Phone:405-353-0203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health