Provider Demographics
NPI:1346421526
Name:HARDWICK, JILL A (LMHC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:HARDWICK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2505
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-2505
Mailing Address - Country:US
Mailing Address - Phone:812-238-4931
Mailing Address - Fax:812-238-4959
Practice Address - Street 1:2901 OHIO BLVD
Practice Address - Street 2:SUITE 251
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-2239
Practice Address - Country:US
Practice Address - Phone:812-238-4931
Practice Address - Fax:812-238-4959
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001624A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health