Healthcare Provider Details

I. General information

NPI: 1104767904
Provider Name (Legal Business Name): EUGENE ALAN HYATT LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 E PECOS RD STE 307
GILBERT AZ
85295-3203
US

IV. Provider business mailing address

2768 W SAN CARLOS LN
SAN TAN VALLEY AZ
85144-4678
US

V. Phone/Fax

Practice location:
  • Phone: 602-842-7042
  • Fax:
Mailing address:
  • Phone: 425-749-0403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLAC-23849
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: