Provider Demographics
NPI:1750861050
Name:HARDMAN, TERESA KEANE (CMHC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:KEANE
Last Name:HARDMAN
Suffix:
Gender:F
Credentials:CMHC
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 274
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:UT
Mailing Address - Zip Code:84325-0274
Mailing Address - Country:US
Mailing Address - Phone:435-881-7754
Mailing Address - Fax:
Practice Address - Street 1:165 W 100 N
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:UT
Practice Address - Zip Code:84325
Practice Address - Country:US
Practice Address - Phone:435-881-7754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT360792-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health