Provider Demographics
NPI:1952829723
Name:HAILS, HEATHER ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:HAILS
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 1:2805 NW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-3930
Mailing Address - Country:US
Mailing Address - Phone:405-949-4200
Mailing Address - Fax:
Practice Address - Street 1:8308 N MAY AVE STE 100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-4551
Practice Address - Country:US
Practice Address - Phone:405-949-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99250161041C0700X
OK64631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical