Provider Demographics
NPI:1083339451
Name:HARDESTY-TESAR, COLETTE REON X (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:COLETTE
Middle Name:REON
Last Name:HARDESTY-TESAR
Suffix:X
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3565 E MARSHALL GULCH PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-2210
Mailing Address - Country:US
Mailing Address - Phone:520-275-8742
Mailing Address - Fax:
Practice Address - Street 1:3565 E MARSHALL GULCH PL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-2210
Practice Address - Country:US
Practice Address - Phone:520-275-8742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-24761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty