Basic Information
| Provider Information | |||||||||
| NPI: | 1598105512 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARDIN | ||||||||
| FirstName: | TIFFANI | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8449 COBB RD | ||||||||
| Address2: | |||||||||
| City: | BROOKSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346018704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523292400 | ||||||||
| FaxNumber: | 3523292401 | ||||||||
| Practice Location | |||||||||
| Address1: | 8449 COBB RD | ||||||||
| Address2: | |||||||||
| City: | BROOKSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346018704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523292400 | ||||||||
| FaxNumber: | 3523292401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2013 | ||||||||
| LastUpdateDate: | 08/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.