Provider Demographics
NPI:1275928061
Name:HAFEN, JAY (ACMHC)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:HAFEN
Suffix:
Gender:M
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4735 N THANKSGIVING WAY
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-2936
Mailing Address - Country:US
Mailing Address - Phone:801-768-8868
Mailing Address - Fax:
Practice Address - Street 1:4735 N THANKSGIVING WAY
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2936
Practice Address - Country:US
Practice Address - Phone:801-768-8868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9256871-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health