Provider Demographics
NPI:1477309524
Name:MASON, HAZEL C (CSUDC)
Entity type:Individual
Prefix:
First Name:HAZEL
Middle Name:C
Last Name:MASON
Suffix:
Gender:F
Credentials:CSUDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10155 N HIDDEN POND DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-3480
Mailing Address - Country:US
Mailing Address - Phone:925-325-0728
Mailing Address - Fax:
Practice Address - Street 1:3784 W VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILLS
Practice Address - State:UT
Practice Address - Zip Code:84062-8085
Practice Address - Country:US
Practice Address - Phone:801-407-9998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13234119-6014101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)