Provider Demographics
NPI:1083400824
Name:HARDGRAVES, TINA
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:HARDGRAVES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 BOWES RD
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5541
Mailing Address - Country:US
Mailing Address - Phone:815-540-7640
Mailing Address - Fax:
Practice Address - Street 1:1135 BOWES RD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5541
Practice Address - Country:US
Practice Address - Phone:815-540-7640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health