Healthcare Provider Details

I. General information

NPI: 1255296125
Provider Name (Legal Business Name): MACKENZIE CHRISTIAN HAYDEN AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MACK HAYDEN AMFT

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S MADISON AVE APT 327
PASADENA CA
91101-3373
US

IV. Provider business mailing address

350 S MADISON AVE APT 327
PASADENA CA
91101-3373
US

V. Phone/Fax

Practice location:
  • Phone: 949-690-9933
  • Fax:
Mailing address:
  • Phone: 949-690-9933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number160230
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: