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General NPI Number Information
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NPI Number | 1861850604
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Entity Type | Organization
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Legal Business Name | HACKETT PSYCHOLOGY, PLLC
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Dates
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Enumeration Date | 02/08/2016
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 12 N CHEYENNE AVE
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City | TULSA
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State | OK
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Zip | 74103-2215
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Country | US
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Telephone | 206-445-0604
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Fax | 206-602-3836
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Provider Business Mailing Address
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Address Line | 12 N CHEYENNE AVE BOX 042
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City | TULSA
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State | OK
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Zip | 74103
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Country | US
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Telephone | 206-445-0604
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Fax | 206-602-3836
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHANNON HACKETT
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Credential | PH.D.
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Telephone | 206-445-0604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PY60604139
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License Number State | WA
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