Provider Demographics
NPI:1083070114
Name:HARDY, TYRONE
Entity Type:Individual
Prefix:
First Name:TYRONE
Middle Name:
Last Name:HARDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 E 6TH ST
Mailing Address - Street 2:SUITE A5A-117
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-1732
Mailing Address - Country:US
Mailing Address - Phone:951-735-5595
Mailing Address - Fax:
Practice Address - Street 1:1655 E 6TH ST
Practice Address - Street 2:SUITE A5A-117
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-1732
Practice Address - Country:US
Practice Address - Phone:951-735-5595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health