Provider Demographics
NPI:1275626244
Name:HARWICK, ELISA HAHL (MA)
Entity Type:Individual
Prefix:MS
First Name:ELISA
Middle Name:HAHL
Last Name:HARWICK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:ELISA
Other - Middle Name:
Other - Last Name:HAHL-HARWICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:2649 W HORIZON RIDGE PKWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4801
Mailing Address - Country:US
Mailing Address - Phone:702-733-8364
Mailing Address - Fax:702-733-7193
Practice Address - Street 1:2649 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 130
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4801
Practice Address - Country:US
Practice Address - Phone:702-733-8364
Practice Address - Fax:702-733-7193
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0249106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist