Provider Demographics
NPI:1003646894
Name:HASENBECK, CATHY L
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:L
Last Name:HASENBECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 SE 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-5201
Mailing Address - Country:US
Mailing Address - Phone:405-831-9739
Mailing Address - Fax:
Practice Address - Street 1:129 SE 1ST ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5201
Practice Address - Country:US
Practice Address - Phone:405-831-9739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)