Provider Demographics
NPI:1053495382
Name:HARDY, DOYLE F (MDIV)
Entity Type:Individual
Prefix:
First Name:DOYLE
Middle Name:F
Last Name:HARDY
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98907-0959
Mailing Address - Country:US
Mailing Address - Phone:509-575-4084
Mailing Address - Fax:
Practice Address - Street 1:1200 CHESTERLY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-7338
Practice Address - Country:US
Practice Address - Phone:509-575-4313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006319101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health