Provider Demographics
NPI:1770187288
Name:HARDIE, SAVANNAH (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:
Last Name:HARDIE
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 CALLE VALLARTA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-3001
Mailing Address - Country:US
Mailing Address - Phone:949-229-0579
Mailing Address - Fax:
Practice Address - Street 1:23732 HILLHURST DR APT 20
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2269
Practice Address - Country:US
Practice Address - Phone:949-229-0579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120332106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist