Provider Demographics
NPI:1750493227
Name:HASSELL, PERRY LEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:LEN
Last Name:HASSELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 FAIRVIEW AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1910
Mailing Address - Country:US
Mailing Address - Phone:580-716-6141
Mailing Address - Fax:580-762-8896
Practice Address - Street 1:5100 N BROOKLINE AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-3623
Practice Address - Country:US
Practice Address - Phone:405-604-3170
Practice Address - Fax:405-948-2745
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK480103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100839670 AMedicaid