Provider Demographics
NPI:1083785240
Name:HAZEN, THOMAS W (CMHC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:W
Last Name:HAZEN
Suffix:
Gender:M
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 E 100 N
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-1665
Mailing Address - Country:US
Mailing Address - Phone:801-592-4040
Mailing Address - Fax:801-423-3154
Practice Address - Street 1:1300 E CENTER ST
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-3554
Practice Address - Country:US
Practice Address - Phone:801-344-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT139747-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health