Provider Demographics
NPI:1972250322
Name:HARDY, MADISON ROSE (MFT-I)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:ROSE
Last Name:HARDY
Suffix:
Gender:F
Credentials:MFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 S GREEN VALLEY PKWY # 1094
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-0404
Mailing Address - Country:US
Mailing Address - Phone:702-748-7580
Mailing Address - Fax:
Practice Address - Street 1:1172 WHISPERING BIRCH AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-5857
Practice Address - Country:US
Practice Address - Phone:702-401-0035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-06
Last Update Date:2022-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist