Provider Demographics
NPI:1831494830
Name:HUDGENS, HAYLEE (LSAC)
Entity Type:Individual
Prefix:
First Name:HAYLEE
Middle Name:
Last Name:HUDGENS
Suffix:
Gender:F
Credentials:LSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3468 APPALOOSA WAY
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-4398
Mailing Address - Country:US
Mailing Address - Phone:801-380-2783
Mailing Address - Fax:
Practice Address - Street 1:8265 W 2700 S
Practice Address - Street 2:
Practice Address - City:MAGNA
Practice Address - State:UT
Practice Address - Zip Code:84044-1323
Practice Address - Country:US
Practice Address - Phone:801-382-6583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7023368-6006101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)