Provider Demographics
NPI:1194694174
Name:HARDIE LLC
Entity type:Organization
Organization Name:HARDIE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:HARDIE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:920-348-3838
Mailing Address - Street 1:8316 REDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-4259
Mailing Address - Country:US
Mailing Address - Phone:920-348-3838
Mailing Address - Fax:
Practice Address - Street 1:5933 STONEY CREEK DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-4401
Practice Address - Country:US
Practice Address - Phone:260-207-4861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-30
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)