Provider Demographics
NPI:1093093866
Name:HAYDEN, KURTIS DEE (LSAC)
Entity Type:Individual
Prefix:
First Name:KURTIS
Middle Name:DEE
Last Name:HAYDEN
Suffix:
Gender:M
Credentials:LSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 N 300 E
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-2620
Mailing Address - Country:US
Mailing Address - Phone:435-586-6654
Mailing Address - Fax:
Practice Address - Street 1:33 N 300 E
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-2620
Practice Address - Country:US
Practice Address - Phone:435-586-6654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT127998-6006101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)