Basic Information
Provider Information
NPI: 1316281231
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HANSARD
FirstName: DAVID
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: RESOURCE MANAGEMENT
Address2: 1300 HOPPE BLVD., SUITE 1
City: ADA
State: OK
PostalCode: 74820
CountryCode: US
TelephoneNumber: 5804367211
FaxNumber: 5802725757
Practice Location
Address1: RECOVERY RESOURCE SERVICES
Address2: 1300 HOPPE BLVD; SUITE 6
City: ADA
State: OK
PostalCode: 74820
CountryCode: US
TelephoneNumber: 5804361222
FaxNumber: 5804361333
Other Information
ProviderEnumerationDate: 11/15/2012
LastUpdateDate: 09/19/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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