Provider Demographics
NPI:1962075150
Name:HARDMAN, JESSICA LEIGH (LMFT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LEIGH
Last Name:HARDMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:LEIGH
Other - Last Name:KAMIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:4535 S LAKESHORE DR
Mailing Address - Street 2:STE 5
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282
Mailing Address - Country:US
Mailing Address - Phone:714-749-5611
Mailing Address - Fax:
Practice Address - Street 1:4535 S LAKESHORE DR
Practice Address - Street 2:STE 5
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282
Practice Address - Country:US
Practice Address - Phone:714-749-5611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-15621106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist