Provider Demographics
NPI:1396856993
Name:TARDIF, RUSSELL PHILIP (MA, MFT)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:PHILIP
Last Name:TARDIF
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Gender:M
Credentials:MA, MFT
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:18700 BEACH BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-2030
Mailing Address - Country:US
Mailing Address - Phone:714-965-9200
Mailing Address - Fax:714-965-9207
Practice Address - Street 1:18700 BEACH BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2030
Practice Address - Country:US
Practice Address - Phone:714-965-9200
Practice Address - Fax:714-965-9207
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAMX23228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist