Provider Demographics
NPI:1932368677
Name:HAYDON, ALEX S (MA)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:S
Last Name:HAYDON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 HEIGHTS DR STE 120
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-7769
Mailing Address - Country:US
Mailing Address - Phone:408-891-1321
Mailing Address - Fax:
Practice Address - Street 1:3330 HEIGHTS DR STE 120
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682
Practice Address - Country:US
Practice Address - Phone:408-891-1321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-07
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA51943106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health