Provider Demographics
NPI:1093010787
Name:HART, CODY
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:HART
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 1:10405 DOUBLE R BLVD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-8905
Mailing Address - Country:US
Mailing Address - Phone:775-827-2400
Mailing Address - Fax:775-827-2488
Practice Address - Street 1:10405 DOUBLE R BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-8905
Practice Address - Country:US
Practice Address - Phone:775-827-2400
Practice Address - Fax:775-827-2488
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1050106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty