Provider Demographics
NPI:1679967228
Name:ASHWORTH, HAYDEN CONNER (RDAT-1)
Entity Type:Individual
Prefix:MR
First Name:HAYDEN
Middle Name:CONNER
Last Name:ASHWORTH
Suffix:
Gender:M
Credentials:RDAT-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1679 MS 3871
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95812
Mailing Address - Country:US
Mailing Address - Phone:424-258-5778
Mailing Address - Fax:
Practice Address - Street 1:600 LINCOLN AVE UNIT 93481
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91109-5760
Practice Address - Country:US
Practice Address - Phone:424-258-5778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-21
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPENDINGOtherCCAP