Provider Demographics
NPI:1790251403
Name:HARDWIG, SAMUEL KEITH (MA, LPC)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:KEITH
Last Name:HARDWIG
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3817 E MONTECITO AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-4138
Mailing Address - Country:US
Mailing Address - Phone:602-524-2500
Mailing Address - Fax:
Practice Address - Street 1:7530 E ANGUS DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6410
Practice Address - Country:US
Practice Address - Phone:480-947-5739
Practice Address - Fax:480-946-7795
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-17561101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty