Provider Demographics
NPI:1598961161
Name:HARDY, DIANE LYNN (LMFT)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:LYNN
Last Name:HARDY
Suffix:
Gender:F
Credentials:LMFT
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 220
Mailing Address - Street 2:
Mailing Address - City:KING CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93930-0220
Mailing Address - Country:US
Mailing Address - Phone:831-392-6555
Mailing Address - Fax:831-525-8296
Practice Address - Street 1:522 BROADWAY ST
Practice Address - Street 2:SUITE D
Practice Address - City:KING CITY
Practice Address - State:CA
Practice Address - Zip Code:93930
Practice Address - Country:US
Practice Address - Phone:831-392-6555
Practice Address - Fax:831-525-8216
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43012106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist