Provider Demographics
NPI:1568523413
Name:HARDIN, PHILIP K (LPC, LMFT)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:K
Last Name:HARDIN
Suffix:
Gender:M
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 1:1401 PINEHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-3125
Mailing Address - Country:US
Mailing Address - Phone:601-925-0707
Mailing Address - Fax:
Practice Address - Street 1:1401 PINEHAVEN RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-3125
Practice Address - Country:US
Practice Address - Phone:601-925-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0596101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MST0118OtherLMFT
MS0596OtherLPC