Provider Demographics
NPI:1144353293
Name:C. HAYDEE MAS, PH.D., PC
Entity type:Organization
Organization Name:C. HAYDEE MAS, PH.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:C.
Authorized Official - Middle Name:HAYDEE
Authorized Official - Last Name:MAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-277-1200
Mailing Address - Street 1:4505 WASATCH BLVD
Mailing Address - Street 2:320
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-4709
Mailing Address - Country:US
Mailing Address - Phone:801-277-1200
Mailing Address - Fax:801-277-8800
Practice Address - Street 1:4505 WASATCH BLVD
Practice Address - Street 2:320
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-4709
Practice Address - Country:US
Practice Address - Phone:801-277-1200
Practice Address - Fax:801-277-8800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT114239-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty