Provider Demographics
NPI:1568515344
Name:HARDWICK, JANE WALKER (LPC LMFT)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:WALKER
Last Name:HARDWICK
Suffix:
Gender:F
Credentials:LPC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 W BERRY ST
Mailing Address - Street 2:SUITE 156
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-2360
Mailing Address - Country:US
Mailing Address - Phone:817-999-8367
Mailing Address - Fax:817-346-5356
Practice Address - Street 1:2701 W BERRY ST
Practice Address - Street 2:SUITE 156
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-2360
Practice Address - Country:US
Practice Address - Phone:817-999-8367
Practice Address - Fax:817-346-5356
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05292101YP2500X
TX779106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX779OtherLMFT
TX05292OtherLPC
TX10009368OtherAMERIGROUP