Mary Shannon Hazen, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

21587 Issued in OK

Practice address

5021 Red Hill Rd
Newalla, OK 74857-8834

Phone

(405) 391-7777

NPI assigned

Apr 19, 2022

Last updated

Aug 19, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Porchlight Counseling and Consulting LLC

  • Clinical Social Worker
  • Newalla, OK
  • NPI 1437941762
  Medicare reassignment NPD Authorized official
• Mental Health Specialty Group PA

  dba Rula Health

  • Mental Health Counselor
  • Durham, NC
  • NPI 1801472634

  OK

  Medicare reassignment NPD
• Tri-City Youth & Family Center, Inc.

  • Community/Behavioral Health Agency
  • Choctaw, OK
  • NPI 1588812895
  NPD (past)
• Tri-City Youth & Family Center, Inc.

  • Mental Health Counselor
  • Choctaw, OK
  • NPI 1881775211
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1650326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755561600000",
    "number": "1043953797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5021 RED HILL RD",
            "city": "NEWALLA",
            "state": "OK",
            "postal_code": "748578834",
            "telephone_number": "405-391-7777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5021 RED HILL RD",
            "city": "NEWALLA",
            "state": "OK",
            "postal_code": "748578834",
            "telephone_number": "405-391-7777"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14625 NE 23rd St",
            "address_purpose": "LOCATION",
            "city": "Choctaw",
            "state": "OK",
            "postal_code": "730208728",
            "country_code": "US",
            "telephone_number": "405-390-8131",
            "fax_number": "405-835-2253",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAZEN",
        "first_name": "MARY",
        "middle_name": "SHANNON",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-19",
        "last_updated": "2025-08-19",
        "certification_date": "2025-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OK",
            "license": "21587",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OSBLSW",
            "identifier": "21587",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881775211",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anna Chorost, LPC
• Justin Anthony Conkling
• Jimmy Cox
• Jefferies Blake Davis
• Erica Elliott, LPC
• Valerie Rene Holzbaugh, PA-C
• Brody Scott Hughes
• Nicholas Hughes
• Tristan Daniel Hughes
• Tamra Realta James, MA, LPC

• Mental Health Counselor in Newalla, OK
• Providers in Newalla, OK by specialty
• Mental Health Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.