Provider Demographics
NPI:1770108946
Name:MEADOW HAZELHOFF COUNSELING, LLC
Entity type:Organization
Organization Name:MEADOW HAZELHOFF COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEADOW
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZELHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:405-219-2271
Mailing Address - Street 1:9524 CONNERS WAY
Mailing Address - Street 2:
Mailing Address - City:MCLOUD
Mailing Address - State:OK
Mailing Address - Zip Code:74851-8668
Mailing Address - Country:US
Mailing Address - Phone:405-219-2271
Mailing Address - Fax:
Practice Address - Street 1:9524 CONNERS WAY
Practice Address - Street 2:
Practice Address - City:MCLOUD
Practice Address - State:OK
Practice Address - Zip Code:74851-8668
Practice Address - Country:US
Practice Address - Phone:405-219-2271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200738420AMedicaid