Healthcare Provider Details

I. General information

NPI: 1558657601
Provider Name (Legal Business Name): PAMELA A HAZELL PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W PACIFIC ST STE D-E
BRANSON MO
65616-4054
US

IV. Provider business mailing address

301 W PACIFIC ST STE D-E
BRANSON MO
65616-4054
US

V. Phone/Fax

Practice location:
  • Phone: 417-339-2634
  • Fax:
Mailing address:
  • Phone: 417-339-2535
  • Fax: 417-339-2634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2011013507
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: