Provider Demographics
NPI:1366022261
Name:HARDING, BOBBI MARIE
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:MARIE
Last Name:HARDING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 W FOURTEENTH ST STE 182
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4051
Mailing Address - Country:US
Mailing Address - Phone:231-409-7030
Mailing Address - Fax:
Practice Address - Street 1:526 W FOURTEENTH ST STE 182
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4051
Practice Address - Country:US
Practice Address - Phone:231-409-7030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011082081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical