Provider Demographics
NPI:1902372311
Name:HANSON, MALLORY JAYMES (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MALLORY
Middle Name:JAYMES
Last Name:HANSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MALLORY
Other - Middle Name:JAYMES
Other - Last Name:BEERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3700 W TECUMSEH RD APT 4205
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-1852
Mailing Address - Country:US
Mailing Address - Phone:214-448-5058
Mailing Address - Fax:
Practice Address - Street 1:3700 W TECUMSEH RD APT 4205
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-1852
Practice Address - Country:US
Practice Address - Phone:214-448-5058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX665151041C0700X
OK78261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical