Provider Demographics
NPI:1407003197
Name:HAZZARD, SHANA LEIGH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHANA
Middle Name:LEIGH
Last Name:HAZZARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 SANGUINET ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-5336
Mailing Address - Country:US
Mailing Address - Phone:817-255-2612
Mailing Address - Fax:817-735-4926
Practice Address - Street 1:3800 HULEN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-7276
Practice Address - Country:US
Practice Address - Phone:817-255-2612
Practice Address - Fax:817-735-4926
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX328471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32847OtherTEXAS STATE BOARD OF SOCIAL WORK EXAMINERS