Provider Demographics
NPI:1629852934
Name:HARDEN, JUSTIN (BACHELORS OF SCIENCE)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:HARDEN
Suffix:
Gender:M
Credentials:BACHELORS OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5562 WIND DRIFT DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7515
Mailing Address - Country:US
Mailing Address - Phone:740-815-8114
Mailing Address - Fax:
Practice Address - Street 1:1339 S YEARLING RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-2071
Practice Address - Country:US
Practice Address - Phone:740-815-8114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health