Healthcare Provider Details

I. General information

NPI: 1649656273
Provider Name (Legal Business Name): STEPHEN J. HARDMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2015
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 E 820 N
OREM UT
84097-5481
US

IV. Provider business mailing address

1450 E 820 N
OREM UT
84097-5481
US

V. Phone/Fax

Practice location:
  • Phone: 385-204-2135
  • Fax:
Mailing address:
  • Phone: 385-204-2135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number75857936004
License Number StateUT

VIII. Authorized Official

Name: MR. STEPHEN J HARDMAN
Title or Position: COUNSELOR
Credential: MHA, MS, LCMHC
Phone: 385-204-2135