Healthcare Provider Details

I. General information

NPI: 1922665249
Provider Name (Legal Business Name): LORAN PATRICK HAYES PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 E 12450 S
DRAPER UT
84020-8058
US

IV. Provider business mailing address

1806 E RIO WAY
SANDY UT
84093-6812
US

V. Phone/Fax

Practice location:
  • Phone: 801-523-3001
  • Fax:
Mailing address:
  • Phone: 831-905-0649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number11111392-2501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number11111392-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: