Provider Demographics
NPI:1962717884
Name:HACKETT, SHANNON (PHD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:HACKETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 N CHEYENNE AVE
Mailing Address - Street 2:BOX 042
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74103-2215
Mailing Address - Country:US
Mailing Address - Phone:206-445-0604
Mailing Address - Fax:206-602-3836
Practice Address - Street 1:12 N CHEYENNE AVE
Practice Address - Street 2:BOX 042
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74103-2215
Practice Address - Country:US
Practice Address - Phone:206-445-0604
Practice Address - Fax:206-602-3836
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60604139103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling