Provider Demographics
NPI:1225003890
Name:HARDEN-HAIG, PEGGY MARIE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:MARIE
Last Name:HARDEN-HAIG
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22900 VENTURA BLVD
Mailing Address - Street 2:260
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364
Mailing Address - Country:US
Mailing Address - Phone:818-224-3320
Mailing Address - Fax:661-254-0336
Practice Address - Street 1:22900 VENTURA BLVD
Practice Address - Street 2:260
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364
Practice Address - Country:US
Practice Address - Phone:818-224-3320
Practice Address - Fax:661-254-0336
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34778106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMF3477800Medicaid