Provider Demographics
NPI:1376817833
Name:HAZELTON, SUSAN (LADC U/S)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:HAZELTON
Suffix:
Gender:F
Credentials:LADC U/S
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:C
Other - Last Name:HAZELTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5228 CLASSEN CIR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-4429
Mailing Address - Country:US
Mailing Address - Phone:405-840-9000
Mailing Address - Fax:405-840-9017
Practice Address - Street 1:5228 CLASSEN CIR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4429
Practice Address - Country:US
Practice Address - Phone:405-840-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health