Provider Demographics
NPI:1255764312
Name:WILCOX, HAZEL (LCSW)
Entity type:Individual
Prefix:
First Name:HAZEL
Middle Name:
Last Name:WILCOX
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:PO BOX 1134
Mailing Address - Street 2:
Mailing Address - City:MAMMOTH SPRING
Mailing Address - State:AR
Mailing Address - Zip Code:72554-1134
Mailing Address - Country:US
Mailing Address - Phone:870-625-0273
Mailing Address - Fax:870-625-0275
Practice Address - Street 1:325 SOUTH 12TH STREET
Practice Address - Street 2:
Practice Address - City:MAMMOTH SPRING
Practice Address - State:AR
Practice Address - Zip Code:72554
Practice Address - Country:US
Practice Address - Phone:870-625-0273
Practice Address - Fax:870-625-0275
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7386-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical