Provider Demographics
NPI:1447709092
Name:HARDIN, ROGER (MA)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:HARDIN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 TERMINAL WAY STE 217
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3258
Mailing Address - Country:US
Mailing Address - Phone:775-624-8200
Mailing Address - Fax:775-624-8222
Practice Address - Street 1:1201 TERMINAL WAY STE 217
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3258
Practice Address - Country:US
Practice Address - Phone:775-624-8200
Practice Address - Fax:775-624-8222
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2705106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist