Provider Demographics
NPI:1083785240
Name:HAZEN, THOMAS W (MED, LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:W
Last Name:HAZEN
Suffix:
Gender:M
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 E 100 N
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-1665
Mailing Address - Country:US
Mailing Address - Phone:801-592-4040
Mailing Address - Fax:801-423-3154
Practice Address - Street 1:1175 E 100 N
Practice Address - Street 2:SUITE 206
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-1665
Practice Address - Country:US
Practice Address - Phone:801-592-4040
Practice Address - Fax:801-423-3154
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT139747-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional