Provider Demographics
NPI:1336657113
Name:HARDEN, LEROY JR
Entity Type:Individual
Prefix:
First Name:LEROY
Middle Name:
Last Name:HARDEN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3027 CHIPWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91978-1966
Mailing Address - Country:US
Mailing Address - Phone:619-779-2872
Mailing Address - Fax:
Practice Address - Street 1:3845 AVOCADO SCHOOL RD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-7319
Practice Address - Country:US
Practice Address - Phone:619-588-3653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health