Provider Demographics
NPI:1093857104
Name:HARDEN, ELIZABETH MARIE (MA LMFT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIE
Last Name:HARDEN
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7171 ALVARADO RD SUITE 100-A
Mailing Address - Street 2:SUITE 100-A
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-8996
Mailing Address - Country:US
Mailing Address - Phone:619-562-2130
Mailing Address - Fax:619-562-2584
Practice Address - Street 1:7171 ALVARADO RD STE 100A
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-8996
Practice Address - Country:US
Practice Address - Phone:619-562-2130
Practice Address - Fax:619-562-2584
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF42549225400000X
CALMFT51329106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner